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PHS-EHD - UNDERGI,,_JND TANK CLOSURE/ABANDONMErTf INSPECTION P� <br /> (SHADE,yD� AREA TO BE FILLED yIN FOR <br /> THE <br /> FIRST TAN,yK�/ ONLY) ypyy y/ <br /> y��N��ri�i 7u�'7k7uJi i ulii/iili5%abr u r r r7%r u ��i����.�v��.'�'yi'7i57u"YiJu�u u u u Pr7uYir ��7ii3u7a��r�i7u u <br /> 2 ro rn 0 E <br /> E OWNER NAME ylD / 0- w� DWNER PHONE # <br /> E , , CONTRACTOR / / F V� CDN. PHONE# D q-61�2J 5 �/ <br /> R i SJLHD PERMIT # P y� 1�y09,yfry� F/IIRE �P�ERMIT # _� y <br /> L <br /> IN PECT,OR <br /> DATE 2� TANK it 39Z- <br /> R RINSED (Y N) METHOD--/4i • RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE I2FF2 � F�ziv�3 5'5�eVIce- q�teRfe� <br /> S' <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOp g 16< AMOUNT USED <br /> V VAPORS PURGED_�Y�N) <br /> A <br /> P. L. E. L. READING AT REMOVAL (MUST B ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (S TEE , FIBERGLASS, OTHER) TANK SIZE/,J <br /> K C <br /> / 0 TANK CONDITIONGOO POOR, HOLES) <br /> N <br /> S PIPE MATERIAL TEEL FIBERGLASS, OTHER) # FEET S <br /> P T u u GL <br /> I PIPING CONDITION (GOOD, POOR OLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A IvL 70af,042 <br /> I N o / <br /> E K <br /> L <br /> D EXCAVATION SIZE: X XI—. YDS OF SOIL: <br /> S ��5 -4�A <br /> I A DEPTH SOIL TYPE BS NATION SphIF'LE # <br /> N M P a !h JCS FX VtlTi� - <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. /F=T SAMPLING METRO e ' <br /> N - 1 D-- <br /> O # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �G(_ ( `� SAMPLERS NiE: 06L <br /> L M � (� <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/$9) DRAW SITE MAP ON REVERSE <br />