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PHS-EHD - UNDERGROU�I TANK CLOSURE/ABANDONMENT �4SPECTION <br />(SHADED AREA TO BE -FILLED IN FOR THE FIRST TANK ONLY) <br />ii/�ivz GAOLf%/.Y//XdA/L ,W/V/lvmnYimirm vnv'.,...—,,,,— _.. <br />E 407Y'< OWNER PHONE # <br />N <br />E <br />AR <br />L <br />^�-'I Y- 34 <br />CONTRACTOR CON. PHONE# W'S Dr,&" s <br />6's o• Ioe <br />SJLHD PERMIT # ._ EPA # /v r} FIRE PERMIT # N <br />INSPECTOR DATE <br />R <br />I <br />RINSED (Y/N) 1,1A - i <br />N <br />RINSATE DISPOSAL SITE N ----91S <br />E <br />MANIFEST # nJf} -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y/N)N., <br />I METHOD <br />AMOUNT USED <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />T <br />R <br />COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />r,4 <br />/ <br />0 <br />N <br />TANK CONDITION (GOOD, POOR, HOLES) N <br />P <br />S <br />T <br />F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET NA <br />I <br />F'IF'ING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />T <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F <br />I <br />A <br />N <br />� <br />P, % <br />No 0400 u7 <br />E <br />K <br />L <br />D <br />S <br />EXCAVATION SIZE: _�' X J-LLX iZ�YDS <br />OF SOIL: ds <br />I <br />N <br />A <br />M <br />P <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X — X <br />YDS OF SOIL <br />I <br />0 <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATEOING: <br />O❑ <br />OTHER SAMPLE: <br />E'TS ,tor 33°Y� l <br />LABORATORY: G� 4 a� l Cc�%l <br />SAMPLERS NAME: P -so <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />23043 (10/89) DRAW SITE MAP ON REVERSE <br />