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PHS-EHD - UNDERI- JUND TANK CLOSURE/ABANDONMeAT INSPECTION r/ <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />11 23043 (10/89) DRAW SITE MAP ON REVERSE <br />r � ��� u�ir u r a i sir ini i? n��udir i u <br />OWNER NAME / <br />E C� <br />OWNER PHONE # o.?o <br />N CONTRACTOR ��wa �� <br />E <br />CON. PHONE# �U� o93,s=7 7o U <br />R SJLHD PERMIT # �'A 2� O�� <br />FIRE PERMIT # gy-07 <br />A <br />L <br />INSPECT <br />DATE j� /?8 <br />TANK # 39 - � y�_ - �-__ <br />R <br />I <br />RINSED N) METHOD -p RINSE AMOUN <br />^eR1NiT/bU U <br />N <br />S <br />RINSATE DISPOSAL SITE/'��JDF �AKERSF7 0 / l <br />v <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED Y/N) <br />METHOD $ CE <br />AMOUNT USED �G a <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE ( 0%) <br />T <br />R <br />COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIAL ( TEEL <br />FIBERGLASS, OTHER) <br />TAN. SIZE <br />/ <br />0 <br />TANK CONDITION (GOOD,- POOR, HOLES) <br />N <br />PIPE MATERIAL(STEEL, IBERGLASS, OTHER) <br /># FEET <br />S <br />P <br />T <br />PIPING CONDITION (GOOD, OOR, HOLES) <br />I <br />N <br />G <br />F <br />T <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />Alo <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: Xlk X <br />YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <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 />U <br /># OF HOURS SINCE DEWATERING: <br />O <br />OTHER SAMPLE: <br />11 <br />LABORATORY:(� CI R <br />SA ILERS N ME `L Oc2P�J <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />11 23043 (10/89) DRAW SITE MAP ON REVERSE <br />