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G PHS–EHD UNDF1` 70UND TANK CLOSURE/ABANDU ''4T INSPECTION <br /> {SHADED AREP BE FILLED IN FOR THE Ff.— TANK ONLY} <br /> f <br /> OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> E r. <br /> R f SJLHD PERMIT # ' <br /> EFA # FIRE PERMIT # <br /> A <br /> L �, f <br /> r 1,1 <br /> INSPECTOR rt DATE ,, TANK # <br /> R RINSE { /N} METHOD RINSE AMOUNT <br /> I hru d <br /> N RINSATE DISPOSAL SITE Opp <br /> Snrr _S <br /> E MANIFEST # –OR– OTHER <br /> V VAPORS PURGE {Y N} METHOD AMOUNT USED <br /> A _T{- l� <br /> P L. E. L. REARING AT REMOVAL (MUST BE { 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL {STEE , FIBERGLASS, OTHER} TANK SIZE <br /> K Cts <br /> d O TANK CONDITION {GOOD, POOR, HOLES} p �r <br /> N ,"fit r+ yc1 YtcL2� <br /> S PIPE MATERIAL {STEEL FIBERGLASS, OTHER} # FEET <br /> I PIPING CONDITION (Goo , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A r r s r7 z r" S fc <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE. X X YDS OF SOILr(F,r <br /> S TC <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X Y <br /> I DS OF SOIL <br /> O H DEPTH TO G o W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: -) s SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 213043 (10/89) DRAW SITE MAP ON REVERSE <br />