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PHS–END – UNDERGROUh' 4. . 11 r-. I <br /> {��� �JK CLOSURE/ABANDONMENT lJCTION <br /> (1/1 mlfrfAjl y,SrHyADED AREA TO BE tLED IN FOR THE FIRST TANK ONLY) <br /> OWNER- NAME <br /> E ,' OWNER PHONE # <br /> E i <br /> N CONTRACTOR <br /> 2 <br /> E CON. PHONE# <br /> R SJLHD PER # <br /> A i EPA <br /> �j#yy� FARE iPERMIT # 1 <br /> L <br /> INSPECTOR y <br /> DATE _ /h7Z <br /> R RINSED (Y/N) <br /> I A METHOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # , <br /> J -OR- OTHER: <br /> V VAPORS PURGEDMETH00 <br /> Fl Nei IAMDUNT USED <br /> P L..E. L. READING AT REMOVAL (MUST BE ( SOX) <br /> R COMMENTS <br /> i <br /> TANK MATERIAL (STEEL, FIBERGLASS <br /> C , OTHER) TANK SIZE OOCa <br /> D TANK CONDITION (GOOD, POOR, HOLES) <br /> N �f <br /> S PIPE MATERIAL (STEEL, FIBERGLASS <br /> T , OTHER) S FEE'( <br /> PIPING CONDITION (GOOD, POOR, <br /> HOLES) <br /> T <br /> DEPTH SOIL TYPE OBSERVATION r <br /> � <br /> A SAMPLE # <br /> tic/ft <br /> N " G �z C � <br /> K <br /> i <br /> EXCAVATION SIZE: clX i_- y <br /> S X .L YDS OF SOIL: E h.e Esr�w. <br /> A DEPTH SOIL TYPE OBSERVATION 30 ' 7�1 <br /> M P SAMPLE # I I <br /> P I <br /> L P <br /> I E <br /> i <br /> N � <br /> G TRENCH DIMENSION <br /> X —. X YDS OF SOIL <br /> H DEPTH TO G. W. : FT SAMPLING H'LTHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> /chic ,Q,or.•l,t , <br /> LABORATORY:` SAMPLERS NAME: <br /> �f/st a6 r �i it CA moo/e f OUuv <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> 043 ( 10/ac)) DRAW SITE MAP ON REVERSE <br />