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RHS—EHD — UNDERGR6— TANK CLOSURE/ABANDONMEN SRECTION <br /> (SHADED��//,,yy AREA T❑ SPILLED I N FOR THE F II//RST TA K ONLY) ��,, <br /> .� rrirr`73i�nr�irrc Arai .uriirr v v )l ! ��'7ji7Y�r a rr it rrME <br /> O 'r it v <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CUNTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR �f �A— DATE 17 q TANK # 39 — I R sj — U s <br /> R RINSED (Y/N) METHOD]—At4/,r- lir RINSE AMOUNT �cf <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —❑R— OTHER <br /> V VAPORS PURGED (Y/N) METHOD ' �6_ AMOUNT USED �0 �fc # )epo <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> GAG = r <br /> 0 a <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA STEE FIBERGLASS, OTHER) TANK SIZE Lf�Dc70 <br /> K C (. <br /> / O TANK CONDITION (GOOD, POOR HOLES) <br /> N f <br /> S PIPE MATERIAL (ST , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING .CONDITION (GOOD,, HOLES) <br /> N <br /> G SOIL TYPE OBSERVATION SAMPLE # i <br /> T DEPTH <br /> F A <br /> I N <br /> E K <br /> L <br />' <br /> D1[ SIRE: X X YDS OF SOIL: <br /> S <br /> i I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> 5 P I <br /> P L P } <br /> I; E I E <br /> rC N <br />` T G TRENCH DIMENSION X X ;:;—FDS OF SOIL <br /> I <br /> O H DEPTH TO S. W. : FTSAMPLING METHOD <br /> N 2 <br /> 4. 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br /> _ i <br />