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UNDE.RGFF, 'ND TANK CLOSURE/ABAND6NME: <br /> (SHADED AREH�� TO 'E FILLED IN FOR THE FIRST NKONLY)INSPECTION <br /> . <br /> OWNER- NAME Oc i <br /> E a r ic G • OWNER PHONE # I <br /> N '. CONTRACTOR— �! <br /> E t hCr-pe 0i I CON. PHONE# <br /> R SJLHD PERMIT # F ~ <br /> A . , . EPA # ��E{CQ`� / <br /> FIRE PERMIT # 1-3 <br /> 0,FF <br /> INSPECTOR DATE f n TANK # i y9 ,I _ <br /> IM <br /> R RINSED Y N) METHOD N }�, �;, <br /> I � iRINSE FlMUUNT <br /> N RINSATE DISPOSAL SITE <br /> s I <br /> E MANIFEST # <br /> -OR- OTHER 4 <br /> V VAPORS PURGED (Y N) METHOD '_r <br /> A r e e AMOUNT USED 3601125 112 fi <br /> f <br /> P L.E. L. i READING AT REMOVAL (MUST BE < 20%) O -���o L� j� I6 <br /> 0 1 I <br /> T R COMMENTS e <br /> N TANK MATERIAL ( TEE , FIBERGLASS, OTHER) 1..i TANK SIZE <br /> { K C h <br /> / © TANK CONDITION (GOOD, POOR HOLES) 511 �M o� <br /> N <br /> j S PIPE MATERIAL (STEE t FIBERGLASS, OTHER) # FEET <br /> P T � � <br /> I or <br /> PIPING CONDITION GOOD POOR, HOLES) <br /> N s t1 VL <br /> G <br /> DEPTH SOIL TYPE OBSERVATION Ij <br /> T r � � SAMPLE # <br /> F A c _� <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: fit ' <br /> YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION I` <br /> N M P SAMPLE # <br /> S P I c77 1 <br /> P L P <br /> E <br /> C N <br /> T G <br /> TRENCH DIMEN81ONX X �. <br /> I `r YDS OF SOIL <br /> o H DEPTH TO G. W. : , <br /> N 2 Fr SAMPL I NSG ME!--HOD <br /> G # OF HOURS SINCE DEWATERING: <br /> IM <br /> O OTHER SAMPLE.- <br /> LABORATORY: <br /> AMPLE:LABORATORY: SAMPLERS NAME:n <br /> CLOSURE IN PLACE MIXTURE: NVOL rt*IE- <br /> 1 2.'.043 ( 10/89) <br /> DRAW SITE MAP ON REVERSE ii h <br />