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tel_ <br /> � S.1LHD - UNDERGROUND TANK CLOSU[tE/A4ANDONML••N'T I NSYk:l:1.1 UN <br /> ' (SHADED AREA TO BE FILLED IN FOR T1fE FIRST TANK ONLY) <br /> E <br /> OWNER NAMEmay/ <br /> � OWNER PHONE � <br /> N CONTRACTOR CON. PNONEI <br /> R 3JLIfD P IT M EPA 1 FIRE PERMIT 1 /jam 9p <br /> LM . <br /> INSPECTOR �, O 7— DATE 16j!�.glp4 TANK 1 39 - 1166 <br /> r r P <br /> I RINSED �N) METHOD T�-�/� RINSE AMOUNlr?jj Sj <br /> S RINSATE DISPOSAL SITE <br /> E MANIFtST M -OR- OTHER <br /> V VAPORS PURGED /N) METHOD ��` "� AMOUNT USED �Ss1'oa- <br /> A /Vitro:.P <br /> •P L.E.G. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS ' <br /> A <br /> N TANK MATERIA STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C 5- ovv <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> P N <br /> PIPE MATERIAL STEEL IBERGLASS, OTHER) 1 FEET <br /> J •�P T C(D� <br /> I PIPING CONDITION (GOOD," POOR HOLES) <br /> N r <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE u <br /> F A /3' e l ®aovz �rS «, l a v <br /> I N �s e- Pte, s <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S; <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> .N M P <br /> S P I A <br /> P L P <br /> E I E <br /> C N �- <br /> T G TR�NCH DIMENSION X X YDS OF SOIL <br /> I <br /> O N DEPTH TO C.N. : FT SAMPLING METHOD <br /> N 2 �'✓ ss <br /> 0 1 OF HOURS SINCE DENATERING: <br /> O OTHER SAMPLE! <br /> LABORATORY: /011' SAMPLERS NAME: dimes <br /> CLOSURE IN PLACE MIXTURE:. <br /> =VOLUME: <br /> L <br /> --____ <br />