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PHS-EHD -- UNDERGR' b) TANK CLOSURE~/ABANDONMEN,.. ,--'NSFJEC -101 f� <br /> (SHADED AREA TO'%Tt F=ILLED IN FOR THE FIRST TANK ONLY) <br /> >�/'�l�ff'�rf ` ll ! i• r •i rr r . , u•r <br /> "CN T S PS <br /> OWNER NAMF�-�S C 1� M F L <br /> E L_ OWNER DHrN �/6 -'2-96-�J35' .' <br /> N CONTRACTORCON. F'i-TONE# <br /> E <br /> R c SJLHD PERMIT # E 'A ��y�j,�y Z FIRE RERMIT # CCJ F�✓�� � <br /> A <br /> L <br /> 5D O <br /> I NSF'EC7 <br /> DATE <br /> R R I NSEDY��N) METHOD- �. Le- A? RINSE AMOUNT" <br /> I <br /> N R I NSATE DISPOSAL SITE <br /> S <br /> E= MANIFEST # -OR- O-F'HER <br /> V VAPORS PURGED ON) METHOD �� � AMOUNT USED i <br /> A ` <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> o <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (( ), <br /> FIBERGLASS, OTHER) T> tNH', SIZE <br /> K C _:- <br /> / O TANK CONDITION (GOOD, F'OO R) HOLES) <br /> N ( <br /> S PIPE MATERIAL (STEEL-, FIBERGLASS, OTHER) ## FEET 7. <br /> - <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N - <br /> G <br /> DEPTH SOIL, TYPE OBSERVATION SAMPLE ## <br /> F A <br /> I N <br /> E FC <br /> L <br /> D EXCAVATION SIZE; X � X _?__ YDS OF SAIL: <br /> S '7 i r <br /> N M 'JI <br /> DEE-,-rH SOIL TYPE OBSERVATION Sr1MPLE #+ I <br /> S rl I I! r ,`I <br /> r <br /> P L F' <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X _- X �-_ YDS OF SOIL <br /> I <br /> METHOD <br /> H DEPTH TO G. W. : V� <br /> iU ? r SAh!F'L I Naz <br /> N E <br /> 0 # OF HOURS SINCE DEWATERING: <br /> I <br /> OTHER SAMPLE: - <br /> �f, <br /> LABORATORY: 15AMPLERS NAI=1EM . <br /> CLOSURE IN PLACE M I XTURE: V[]1__LJh1E <br /> H 232043 ( 1C)/89) DRAW SITE mni=' O!V [REVERSE <br />