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PHS-EHD - UNDERGi,-JND TANK CLOSURE/ABANDONME!-1- INSPECTION I6� F <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> rr r u p � � u V r r u <br /> PtA RF rc C6 n n wtv o w S>Km C S2o <br /> OWNER NAMEPV<R re) Cawl wtn OWNER PHONE # NjW61--2j c1� <br /> E <br /> N CONTRACTOR e p NL CON. PHONE# <br /> E GFrd IDq <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # �_o ! <br /> A <br /> L -- <br /> INSPECT DATE ?� 9� TANK # 39 <br /> R RINSED Y N METHODY; ���� R INSE AMOUNT I Z <br /> I LLff" <br /> N RINSATE DISPOSAL SITE �� F� NERIr,-S S6ewiCe". A77�Z5°` <br /> 9 <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHODD� AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE � Q <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIA (STEEL, FIBERGLASS, 4HER) # FEET S f^ <br /> P T <br /> I PIPING CONDITION (GOOD, F'OOR HOLES) i ' Ca JPs <br /> N j �r ova A <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N 3 <br /> E K <br /> L <br /> D EXCAVATION SIZE: ID X X -7 YDS OF SOIL: ;?-0 * <br /> S "— <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P IG V 2 L ✓ G✓1 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : .(4L1L�-- FT SAMPLING METHOD o <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: 'TitKF - <br /> 0 OTHER SAMPLE: <br /> LABORATORY: (�L SAMPLERS NAME• Kk <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23043 ( 10/B9) DRAW SITE MAP ON REVERSE <br />