Laserfiche WebLink
w',LJzrll2hLJUN ANK CLOSURE/ABANDONMENT <br /> (SHADED AREA TO Fc!l-,mWLLED IN FAR THE FIRST T K ONLY) ON <br /> . <br /> OWNER- NAME a <br /> E OWNER PHONE # <br /> N % CONTRACTOR <br /> ECON. PHONE# <br /> R SJLHD PERMIT # y <br /> A. ., , EGA ## FIRE PERMIT # '� <br /> INSPECTOR c. DATE / TANK # <br /> 3o y <br /> ! C1. <br /> R RINSED Y ) METHOD <br /> I ssure� RINSE AMOUNT��� $ <br /> N RINSATE DISPOSAL SITE _ p' p S <br /> E MANIFEST # �e �_ <br /> -OR-- OTHER s <br /> V VAPORS PURGED �N) <br /> A METHOD AMOUNT USED <br /> P L.-E. L. READING AT REMOVAL (MUST BE ( 20% 5'dr6s <br /> 0 O/ <br /> T R COMMENTS <br /> R <br /> q r <br /> TANK MA7CRIAL (STEEL FIBERGLASS, OTHER) <br /> C TANK SIZE 55 <br /> O TANK CONDITION (GOO POOR PO=HQLr-S) <br /> N <br /> S PIPE MATERIAL (STEEL FIBERGLASS, <br /> T� OTHER) # FEET <br /> a ,:. <br /> PIPING CONDITION (GOOD POOR, CIN4'NoLu..� <br />� + OOR HOLES) - <br />'r <br /> DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # - <br /> A c r 1 <br /> N SCn oRr170N SC7c4 <br /> K <br /> i. <br /> EXCAVATION SIZE: X <br /> S -�-. X .L_ YDS OF SOIL: <br /> A <br /> DEPTH SOIL TYPE OBSERVATION <br /> M P SAMPLE # <br /> P I <br /> L P <br /> I E 4 <br /> N ' <br /> G TRENCH DIMENSION X <br /> -�-+ - X YDS OF SOIL , <br /> H DEPTH TO <br /> FT SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE; <br /> LAUGRATORY: <br /> SAMPLERS NAME <br /> CLOSURE ..IN PLACE MIXTURE: <br /> VOLUME: <br />.,043 (10/81) <br /> DRAW SITE MAP ON REVERSE <br />