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PHS—END — UNDERGROUN R �JK CLOSURE/ABANDONMENT 11CTION <br /> (SHADED AREA TO BE LED IN FOR THE FIRST TANK ONLY) <br /> ;�w /�'s.��i�:���"w����"�'",�ra:�,r <br /> 'z1fln%{ <br /> OWNER- NAME OWNER PHONE #1' <br /> E Musky o P <br />'N CONTRACTOR <br /> E � Bask• �hnvP/ n�ccu 6H CON. PHONE# <br /> R S,ILHD PERMIT # <br /> A . f / EGA # FIREI,PERMIT # <br /> r / < <br /> INSPECTOR C /,/uti i DFlTE�o�/S�)1 TANK # 39 — /6 7.t <br />` R RINSED (Y/N) METHOD <br /> I RINSE FlM0UN7 <br /> N RINSATE DISPOSAL SITE �,4 <br /> S <br /> E MANIFEST # OTHER <br /> V VAPORS PURGED (Y/N) METHOD NA AMOUNT USED <br /> A <br /> P L.E. L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> f R COMMENTS <br /> I <br /> J TANK MATERIAL (STEEL, FIBERGLASS TJ <br /> C , OTHER) TANK SIZE <br />' 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N o <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) i( FEE ( <br /> T <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> I <br />' DEPTH SOIL TYPE OBSERVATION <br /> T �I SAMPLE # <br /> Arcole;-, 1,oNr. eY C I N <br /> N . c <br /> K <br /> EXCAVATION SIZE: � X �— X ', <br /> S 1_ - YDc,, !;OF SOIL: <br /> 3rJ �1a�1r <br /> A DEPTH SOIL TYPE OBSERVATION <br /> M P SAMPLE # <br /> PI <br /> L P <br /> I E <br /> N <br /> G <br /> TRENCH DIMENSION X <br /> X YDS OF SOIL <br /> H DEPTH TO G. W. : <br /> FT SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: ) <br /> O OTHER SAMPLE: <br /> LABORATORY: <br /> G��im; . .9uol.f <br /> W�f lodoivfv, � ,,�;r CA SAMPLERS NAME: y <br /> CLOSURE IN PLACE MIXTURE: /4°6pr' Mor{ <br /> VOLUME: <br />:2043 ( I0/89) DRAW SITE MAP ON REVERSE <br />