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PHS-EHD - UNDEN,r _IND TANK CLOSURE/ABANDONr,. ,.f INSPECTION <br /> (SHADED AREA /Td-BE FILLED I <br /> ILLEDI N FOR THE <br /> FIRST TANK y ONLY) <br /> � _ � L'ii6.�ula�/b�yi�ylGLrX�.fv/[� 1LILlvlli ,Y����J;��J;�,;Ypuy,���Lv���Gi7LJW�.�IFJuJ1%7irXGYJi ��ri��v�ja� <br /> OWNER NAME S�f}- OWNER PHONE # <br /> E <br /> E Co CGN. PHONE# <br /> c roc ooc ���b33 <br /> SJLHD PERMIT # EPA # FIRE PERMIT <br /> L <br /> INSPECTOR 6�, DATE � � TANK # 39 - - <br /> R RINSED (Y N) METHODRINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST -OR- OTHER <br /> V VAPORS PURGED Y%N> METHOD <br /> A AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) �Z j��o <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ($TE <br /> K C S, FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION illioD, POOR, HOLES) nci rp� jp - <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET F� (fytlz <br /> P T Ol � i <br /> I PIPING CONDITION OOD POOR, HOLES) �t.�_ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N c p <br /> Cfi�C.O,L'. P.DULJ�-u lug ci A -p}, <br /> E K cA 4 a 2 <br /> L <br /> D EXCAVATION SIZE: y_ 1 <br /> S X I�` X � YDS., OF SOIL; <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I U <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF: SOIL -� <br /> 0 H DEPTH TO G. W. /r` /r, F <br /> N T ,AMPLING METHOD 1lilq!(p fp <br /> � Nz' <br /> 0 # OF HOURS SINCE DEWATERING: r <br /> 0 OTHER SAMPLE: <br /> LABORATORY: Z SAMPLERS NAME: M" ' 77FP)A <br /> CLOSURE IN PLACE MIXTURE: f' -- VOLUME: i <br /> EH 3043 ( 10/69) DRAW SITE MAP ON REVERSE <br />