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PHS-EHD - UNDE JOUND TANK CLOSURE/ABANDCr' <br /> iNT INSPECTION <br /> (SHADED ARE,yd1l�t/E ,yFILLED IXNrWin <br /> �F�J,OR THE FI1 TANK ONLY) <br /> iiJ�If v �y �yy"/vh��Y r v i Jilii <br /> OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> J22 l s10� N <br /> R SJLHD PERMIT # EPA #C <br /> . A • , FIRE PERMIT # '/30/17 <br /> L i <br /> INSPECTOR C DATES TANK' # 39 - <br /> lr o � <br /> R RINSED (Y N) METHOD �� '} RINSE AMOUNT—. <br /> • I i! <br /> N RINSATE DISPOSAL SITE -- - �' <br /> S <br /> E MANIFEST # -OR- "OTHER <br /> f V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 2C)%) <br /> 0 ,a <br /> T R - COMMENTS <br /> N TANK MATERIAL( (STEE <br /> K FIBERGLASS' OTHER} TANK SIZE Z;- <br /> 00�� <br /> C ,1 <br /> / 0 TANK CONDITION '(GOOD, POOR, HOLES) I i <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET k <br />` P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N i3 <br /> E K <br /> 'L u <br /> D EXCAVATION SIZE: g X X YDS OF SOIL: <br /> S g o/S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I f NJ do d J o a o �cL✓ . i. <br /> P L P r a R rs�n - / �• <br /> E I E H <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I ---- <br /> 0 H DEPTH 70 G. W. : FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: � , Wei- SAMPLERS NAME: <br /> Lei sij <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> ,L h <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br /> iL <br />