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PNS--EHD - UNDERGR TANK CLDSURE/ABANDONME NSF'ECTION 1 <br /> (SHADED AREA TO ' <br /> ,FILLED IN FOR THE FIRST TAK ONLY) <br /> ���" a " `�Ill' '''"1' : 5� "9 1 ; <br /> OWNER NAME OWNER PHONE .# <br /> N CONTRACTOR ' :CON. ,.PHONE#. <br /> 3 <br /> y $ S-,;LS <br /> E ,S _C"c� 5 _u1G' a� <br /> R S3LHD PERMIT # -EPA # FIRE PERMIT #,ff aM�� LV�no <br /> A <br /> L <br /> INSPECTOR CJ 7� DATE /��� =T.ANK'-# 39. <br /> R RINSED N) - METHOD r -RINSE AMOUNT . , �yrllS <br /> I <br /> N RINSATE. .DISPOSAL:. SITE _ j' <br /> S 1//e 6l <br /> E MANIFEST # `T -OR- =OTHER <br /> V VAPORS PURGED N) METHOD �r �� AMOUNT. USED .^ <br /> P L. E. L. .READING AT REMOVAL . (MUST RE < .20%) <br /> T R COMMENTS <br /> A <br /> N TANK. MATERIAL (STEE , FIBERGLASS, ..OTHER} FTANK SIZE /Ddl'0 <br /> K C <br /> i <br /> / O TANK CONDITION GOOD POOR, HOLES) , <br /> N + <br /> x . S PIPE MATERIAL S7 EE FIBERGLASS, OTHER) # .FEET <br /> P T 4 <br /> ; <br /> A <br /> L _ <br /> I PIPING CONDITION (GOOD, aR, HOLES) .. <br /> N ,. <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE' # <br /> T � ' ' <br />! F A / <br /> I N <br /> a E K - . <br />'f D EXCAVATION SIZE: 30 X 22 X ' YDS OF SOIL:/%- <br />'i S _ <br /> I A DEPTH SOIL_ }TYPE 'OBSERVATION �, SAMPLE # <br /> N M P ' <br /> S P I ! F isc /U74�insr <br /> P L ' P <br /> E I E 3x44 ' r� .i . . Ze <br /> lit <br /> T G TRENCH DIMENSION S X �� X I� YDS OF SOIL C xpy <br /> O HDEPTH TO G:W. : FT SAMPLING METHOD <br /> N 2 _ _ <br /> 0 # OF HOURS ,SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> - <br /> LABORATORY: AMPLERS NAME :r-,iL <br /> CLOSURE IN PLACE .MIXTURE: {`�' VOLUMEe <br /> ;EH 23443 DRAW SITE MAP ON REVERSE <br /> _ .. <br /> INSPECTOR RECEIVED BY: -W_-_----_---_--- - � <br /> OM ORIGIi\lA!_ HUT-4 5/88 ; <br />