Laserfiche WebLink
UNUhNWROU <br /> ND TANK CLOSURE/ABANDONMEP' ' 'NSPECTION C� <br /> reyff% <br /> (SHADED AREA TC FILLED IN FOR THE FIRST ..4K ONLY)g4AV.�f�'Y/y 0Am <br /> VA <br /> OWNER NAME S <br /> E l.�r,C�•a M. 1a ., f ��,a.., �aC, OWNER PHONE # 2- O9 3 --~]D -7/ <br /> CONTRALTO !� <br /> �1- I�1K �• CON. PHONED 2 O cr` 9? <br /> R SJLHD PERMIT # EPA 2ds�j 4�/ LD <br /> A FIRE PERMIT iN34iff <br /> L rp <br /> INSPEC O GATE !l—lZ-� j TANK # <br /> R RINSED YON) I METHOD <br /> /� /2e,.�5 RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> _OR_ OTHER <br /> V VAPORS PURGED (Y/ ) <br /> A METHODS <br /> R, AMOUNT USED Q <br /> P L. E. L. READING AT REMOVAL (MUST B <br /> T R COMMENTS <br />-A <br /> N TANK MATERIAL kSTEE , FIBERGLASS, OTHER) TANK SIZE p <br /> K C ?iD <br /> / O TANK CONDITION (GOOD, POOR HOLES) �J <br /> S PIPE MATERIAL TEEL FIBERGLASS, OTHER) ## FEET ' f <br /> P T /O <br /> I PIPING CONDITION (GOOD, POOR, HALES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> FN �W As, <br /> I <br /> E K <br /> L <br /> D EXCAVATION SIZE: qq / <br /> , <br /> I A x �_ x YDS OF SOIL: y d <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> L P <br /> 1 E <br /> r <br /> ( N <br /> r G TRENCH DIMENSION <br /> r --� x --- x YDS OF SOIL <br /> I �. <br /> H DEPTH TO G. W. : I FT <br /> SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: P4,> <br /> 0 OTHER SAMPLE: <br /> LABORATORY: S� h UA-(- . <br /> SAMPLCRa NAME: Ll uis <br /> CLOSURE IN PLACE MIXTURC: <br /> vOLUMC: <br /> X43 (10/891 V �► DnAW SITE MAP ON REVERSE <br />