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AS—EHD — UNDERC;�}��JND TANK CLOSURE/ABANDONMG <br /> (SHADED AREA TU tfE FILLED IN FOR THE FIRST TANK SONLY) ON <br /> E OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> , <br /> R. # <br /> SJLHD PERMIT # EFIRE PERMIT # <br /> A '�� , PA <br /> L <br /> INSPECTOR DATE I TANK # 39 <br /> R RINSED N) METHOD %r� <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE CW _tl <br /> S r d, <br /> E MANIFEST # <br /> —OR— OTHER <br /> V VAPORS PURGED (VN)" <br /> METHOD <br /> A �Y� AMOUNT USED I <br /> P L..E. L. READING AT REMOVAL (MUST PE ( �O;c) 0 1 <br /> aLL <br /> O /u <br /> T R COMMENTS <br /> A <br /> N iiiii;iTANK MATERIAL STEEL, FIBERGLAS , OTHER) TANK SIZE <br /> K C \ <br /> / 0 TANK CONDITION GOOD, POOR <br /> N , HOLES) /U� ✓%o0 pe no G-01 <br /> S PIPE MATERIAL (STEEL, FIBERGLASS ' <br /> P T , OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) I <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F q SAMPLE # ! <br /> I N <br /> E K � 02 oI fSco�o2A no � rJc Tzw�s rJ' i FCPl� <br /> L l y- _ <br /> D EXCAVATION SIZE: r2 It .m l3lc� <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N <br /> S P I <br /> P L <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION j <br /> I X X YDS OF SOIL <br /> 0 HDEPTH TO G. W, : <br /> N E -- FT SAMPLING METHOD i <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ! <br /> SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: <br /> VOLUhIE: � <br /> 3043 (10/89) DRAW SITE MAP ON REVERSE <br />