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LANU TANK CLOSURE/ABANDONME <br /> (SJ,HADE�D�/ AREA �aTO- FILLED IN FOR THE.;, FIRST,*,,"� KSONLY) N r <br /> �. . <br /> OWNER- NAME <br /> E PSA- S OWNER PHONE <br /> N CONTRACTOR <br /> E y CON. PHONE# <br /> �(p <br />'rt R •. S.ILHD PERMIT # �, J <br /> ,f r•P <br /> INSPECTO DATE <br /> g� 'TANK <br /> R RINSED (Y/N) METHOD <br /> I ,�l RINSE FIMUUN7 <br /> N RINSATE DISPOSAL SITE <br />.i. E MANIFEST # <br /> -OR-' OTHER <br /> V VAPORS PURGED (Y/ ) METHOD <br /> A AMOUNT USED 33� <br /> P L.E.L. READING AT REMOVAL (MUST RE ( GX) <br /> T R COMMENTS r U <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, <br /> K C OTHER) TANK SIZE/� <br /> ' <br /> 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N f s <br /> A S PIPE MATERIAL (STEEL, IBERGLASS, OTHER) ## FEET <br /> P T 3 <br /> I PIPING CONDITIO GOOD, BOOR, HOLES) <br /> N f At 0#ey <br /> G DEPTH SOIL TYPE OBSERVATIONl <br /> T SAMPLE # <br /> F A Gvi✓, <br /> I N N <br /> E K .0 i <br /> L o U <br /> D EXCAVATION SIZE: XX G] <br /> S .-sem- YDS OF St]I t : 11 <br /> I A DEPTH SOIL TYPE OBS�j-�V TION !J <br /> N M P SAM LE it <br /> P L p e o <br /> E. I E <br /> /✓ A <br /> C N v O D,Q <br /> T G TRENCH DIMENSION X �( X <br /> I YDS OF SOIL. <br /> 0 H DEPTH TO G. W. . <br /> N ;�---,.� FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUMC: <br />:H 23043 . (10/89) DRAW SITE MAP ON REVERSE <br />