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PHS–EHD – UNDERG..c)UND TANK CLOSURE/ABANDONML-4T INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />....................................................................................................................................................................................................................................................... <br />!4��uri�iu�ua%uuiuf rir� <br />.� <br />n%iin��fu <br />N <br />!� <br />OWNER NAME /�/ <br />E W (� <br />OWNER PHONE # ZU� 23ci i <br />N C�TRA� wA eSov2Cej SNC <br />E <br />CON. PHONE# 8�� �3S'— •7 •7p O 1 <br />R SJLHD PERMIT # F'R # <br />A r�"fYFY"`Y'I(Y'`�C�if�- <br />L <br />� <br />FIRE PERMIT # <br />_ �S{YIFY /iiiir r <br />INSP <br />DqT- a <br />TANK # 39 <br />R <br />I <br />RINSED YON) METHOD RINSE AMOUNT r2 V U <br />1 <br />N <br />S <br />RINSATE DISPOSAL SITE /�So�/ I?tf /f'l2/_fy7'e <br />E <br />MANIFEST # -OR- OTHER <br />V <br />R <br />VAPORS PURGED (Y/IV) <br />METHOD �R �L� <br />AMOUNT USED /GG <br />P <br />0 <br />L.E.L.READING AT REMOVAL (MUST BE ( 20%) [ o <br />F7 0 <br />T <br />A <br />R <br />COMMENTS <br />N <br />TANK MA'fERIRLSTEELY FIBERGLASS, OTHER) <br />TANK biZ,E j DU O <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />N <br />F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) <br />FA FEET <br />S <br />P <br />T <br />I <br />F'IF'ING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />R <br />I <br />N <br />- <br />E <br />K <br />L <br />EXCAVATION SIZE: ZY X :/ X l� <br />YDS OF SOIL: <br />D <br />S <br />I <br />N <br />A <br />M <br />P_ <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />S <br />F <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.: F=T <br />SAMPLING METHOD <br />N <br />U <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: J.0 LFI6oRP�-iD2S11PL <br />RS NAME <br />CLOSURE IN PLACE <br />MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE-: <br />c <br />Op <br />