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PHS-EHD - UNDERG OND TANK CLOSURE/ABANDONMEO INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> VA <br /> ORIN <br /> r� 9.Tu,o� <br /> OWNER NAME �. I�RG� l-1 OWNER PHONE <br /> E # i(Ole _ZO03 <br /> N CONTRACTOR Aev" W2(dcC 4 'OVto CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # C3cCc44 FIRE PERMIT # <br /> i <br /> A <br /> L <br /> INS'P'ECTOR DATE TANK # 39 <br /> R RINSED `(Y/N) METHOD RINSE AMOUNT -�DC�CL rIJ5 <br /> I <br /> N RINSATE DISPOSAL SITE l CJ IL IZecyc�'7zs SM P <br /> S IV cwp 2 � <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N> METHOD 1 r� I AMOUNT USED73C) <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE C 20%) L �Z�D C)Z 3,�7 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK. MATERIAL `kTEEJL, FIBERGLASS, OTHER) TANK SIZE <br /> K, C <br /> 0 TANK, CONDITION (GOOD, POOR, HOLES) ,.-i_,C'HT CCK9C*,i� 6VipU-QT- <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET Jwec-tif ab,Ne <br /> P T CL w <br /> I PIPING CONDITION (GOOD, POOR ) HOLES) CorrcSion e\(t rte' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A L I <br /> I N ti $ <br /> E K <br /> L <br /> D EXCAVATION SIZE: --L. ) _ X __I_. YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TY - OBSERVATION-/ SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X -X �_ YDS OF SOIL — <br /> I <br /> 0 H DEPTH TO G. W. : Mn T SAMPLING METHOD <br /> N = <br /> G # OF HOURS SINCE DEWATERING: <br /> ❑0 OTHER SAMPLE: -- <br /> LABORATORY: CSL l�fr �L SRIPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: Jlp <br /> EH 23043 ( lo/B9) DRAW SITE MAP ON REVERSE <br />