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RHS-EHD - UNDERGRj '' TANK CLOSURE/ABANDONME� c <br /> (SHADED AREA TO ♦rvrLLED IN FOR THE FIRST -n%O ONLY)ONLY) <br /> r ZiDOlitl�ccio!/��,t L� c�tri <br /> OWNER NAME <br /> OWNER PHONE # � ?Z? - 0a,j; <br /> N <br /> CONTRACTOR CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> / u � <br /> INSPECTO ,G'V DATE c� TANK # 39 <br /> I <br /> RINSED �N) METHO ��^� �/ �--FR I NSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> t <br /> V VAPORS PURGED N) METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) G� <br /> 0 <br /> T R COMMENTS " <br /> A <br /> N TANK MATERIAL tjet , FIBERGLASS, OTHER) TANK SIZE <br /> K C / o co <br /> / 0 TANK CONDITION (GOOD, OOP, HOLES) ' <br /> N <br /> S PIPE MATERIAL. EEL: FIBERGLASS, OTHER) _ T # FEET 7 <br /> P T vv <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N t <br /> G T I DEPTH SOIL TYPE OBSERVATION I SAMPLE # <br /> F <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: L X '!/ _X YDS OF SOIL: <br /> S <br /> i A RTRFH.l <br /> SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I - <br /> P L P <br /> � E I E <br /> C N <br /> T G IMENSION X X YDS OF SOIL <br /> I <br /> 0 HO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0RS SINCE DEWATERING: <br /> OMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> a <br /> CLOSURE IN PLACE MIXTURE:. ( VOLUME: <br />.H 2=04'7 CIO/89) DRAW SITE MAP ON REVERSE <br />