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RHS-EHD - UNDERGROI TANK CLOSURE/ABANDONME* NS' r� <br /> (SHADED AREA T"� FILLED IN FOR THE FIRS 1,1JK ONLY) N r <br /> �r <br /> o ,de- S S,K. <br /> E OWNER•-NA n 7G <br /> OWNER PHONE # / <br /> � <br /> N CONTRACTOR �y�,, -�F� •0 <br /> E A 11�-nYVK CON. PHONE# <br /> R .. SJLHD' PERMIT # EFA �6S��y 4 <br /> A FIRE PERMIT # G'^' D } <br /> L <br /> I NSPECTO GATE <br /> R RINSED Y N) METHOD'j�' <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL -SITE <br /> S <br /> E MANIFEST # <br /> -0R- OTHER <br /> V VAPORS PURGER {Y N) METHO AMOUNT USED <br /> �, <br /> A <br /> ;-- <br /> L.E. L. READING AT REMOVAL (MUST E ( 20;x) <br /> Q LF,(,_0 <br /> T R COMMENTS <br /> A S <br /> N TANK MATERIA "(STE[E <br /> K FIJBERGLA <br /> C SS, OTHER) TANK SIZE <br /> / O TANK CONDITION (GOOD, POOR, HOLES 3 / I� ¢ r/ S <br /> N � <br /> • S WIPE MATERIA (STEEL, FIBERGLASS, OTHER) #( FEET <br /> 7ik <br /> P T / <br /> I PIPING CONDITION (GOOD POOR, HOLES) - <br /> N <br /> 0 DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N — <br /> E K <br /> L / <br /> D EXCAVATION SIRE: <br /> S X X � YDS OF SOIL: L4 ds . <br /> I A DEPTH SOIL TYPE <br /> N M P OASEftV,ATION . AMPLE # <br /> EY E L-J - o cr <br /> C N s, 5_71- a <br /> T G TRENCH DIMENSION <br /> I xX YDS .OF SO I L <br /> O H DEPTH TO G. W. : <br /> N E ..-- FT - ..SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: leo We K p,-^CO kA rd <br /> O OTHER SAMPLE: <br /> LABORATORY: <br /> 5f&0066 Prt SAMPLERS NAME: ,L <br /> ([!5 _eA ✓ <br /> CLOSURE IN PLACE MIXTURE: ` <br /> 01; gill VOLUME: <br /> H 22042 ( 10/� 1aq) DRAW SITE MAP DN. .REVEfiSE <br /> I If X <br />