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WNUizkURUUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHAPED AREW.TO E B=ILLED IN FOR THE PIAST NK ONLY) <br /> PT- <br /> OWNER NAME ,r <br /> OWNER PHON # .-- <br /> N CONTRAC:TO - -Io <br /> E " . CON. RHONE# tit t 1 <br /> SJLHD "PERMIT # <br /> A• Pg"M I1` <br /> AleL <br /> �NSPEC <br /> TANK t# 39 - <br /> R RINSED (Y/ <br /> METHOD <br /> I RINSE AMOUNT <br /> N RINSATe DISPOSAL SITE <br /> E MAN I FES' <br /> -OR- OTHER <br /> v VAPORS PURGE® tY N� METHOti <br /> A AMOUNT USED <br /> P Ly.E. L. READING AT RCMOVAL (MUST SE t �ax) �.� = to <br /> 0 <br /> A <br /> COMMENTS7, a <br /> N <br /> `SANK MATERIAL rCEL� IIIERI LASS OTHER) TANK SIZE �a <br /> lc ��^ <br /> / 0 'TANK CONDI ' ON . ( Obb POORo HOLES) <br /> ` • S PIPE MATERIAL E <br /> P T 1 #0THq ) # FEET r <br /> I l IPINS CONOITJDN � .N i <br /> N r HALES) <br /> DEPTH SOIL HYPE 08911 �VArION <br /> .. SAMPLE # <br /> A <br /> N <br /> L Div I <br /> D YDS OF SOIL , <br /> EXbAVATION SIZE# <br /> S <br /> I A <br /> DEPTH SOIL TYPE OAS S <br /> A,o- <br /> N M P VAraN SAMPLE # <br /> S P I <br /> P L P <br /> o <br /> E Iv C4, o .. g77 olto/ <br /> C N _ <br /> ' ENDIMENSION <br /> 8�7 pi 111 <br /> s . , <br /> T G YDS O SOI <br /> CH D�MENS I C1N � <br /> r x L <br /> a <br /> H DEPTH TOOi N� Nth METHOD <br /> 0 'HOURS SINCE bEWATERINSt <br /> 0 OTHER SAMPLCt <br /> .. <br /> LABORATORY <br /> s <br /> C: SAMPLER-03 NAOC- : <br /> CLOSURE IN PLACE M XTU�tC. <br /> VOLUME: <br /> .11U3 (10/89) <br /> DRAW 52rE MAP ON <br /> -PEVERSE <br /> _ t <br />