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........nom r ;-1,ERGROUND TANK CLOSURE/AlUf' ')NML•'N1' IN5YF;l'1'lUN <br /> (SHADED ATO BE FILLED IN FOR THLRST TANK ONLY) <br /> IG OWNER NAME ; i/� <br /> N ` Brrc� Jose ` OHNER PHONE II ���J �a3 -da•,�� , <br /> CONTRACTOR CON. PHONEq <br /> E /�/arc �a eo�r- CY(f� <br /> R ! SJLHD PERMIT I <br /> EPA YCN[vooS-? FIRE PERMIT q u"' <br /> INSPECTOR DATE <br /> . 3/7/9i TANK Y 39 <br /> R RINSED ) METHOD <br /> I �/�t RINSE AMOUNT <br />` N RINSATE DISPOSAL SITE <br /> S s uy <br /> E MANIFEST <br /> - -OR- OTHER <br /> V VAPORS PURGED (CUN) METHOD <br /> A pCcyi�e AMOUNT USED /5D/4-5- <br /> v P L.E.L. READING AT REMOVAL (MUST BEj1C 203) <br /> Y0 <br /> T R COMMENTS <br /> A n ) <br /> (r� N TANK MATERIAL ( TEED FIBERGLASS, OTHER) TANK SIZE S,vvo <br /> l Q K C ,; � <br /> / 0 TANK CONDITION (GOOD, <br /> P POOR, HOLES) <br /> N <br /> , I S PIPE MATERIAL (STEEL; FIBERGLASS, OTHER) Y FEET <br /> 3 P T , <br /> \ I <br /> N PIPING GOND N (GOOD, POOR, HOLES] <br /> t <br /> G DEPT SOIL TYP <br /> T E OBSERVATIONt } <br /> SAMPLE 4 <br /> N <br /> E K /E <br /> L -; <br /> DEXCAVATION SIZE: �� <br /> g; XYDS OF SOIL: /V <br /> I A DEPTH SOIL TYPE OBSERVA ON 'a { <br /> N M P SAMPLE p I <br /> S P I <br /> P L P . <br /> E I E <br /> C N <br /> Z G TR$NCH DIMENSIO _ _ X X <br /> YDS OF SOIL <br /> O H DEPTH TO G.H.: <br /> N 2 FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> a 1y-k SAMPLERS NAME: N' 0L <br /> CLOSURE IN PLACE MIXTURE; R <br /> VOLUmE <br /> 1{II 2;I 04:1(7/88) ARAN SITE MAP ON REVERSE <br /> it <br /> ii <br />