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PHS-EHD - UNDFRA,.IND TANK CLOSURE/ABANDONM,a,,.r INSPECTION <br /> (SHADE,D/ AREA TO�ypyB�E�/yGyFILLED <br /> IyN� FOR THE FIRST TANK ONLY) y�y� <br /> � y���� f����v��������4i.WdiN.Ui.Wi+v��.CL7/i/LZv"Lb Jay��/�.y�yy�,��,:UiI6Xa�•(!%7,Yxi�li�'Y�� ��i��u�i /LI�i <br /> OWNER NAME <br /> E OWNER PHONE # � <br /> N CONTRACTOR SA)c4, ✓, e St�f c - <br /> E CON. PHONE# ,/ <br /> R STLH ' PERMIT # EPA # C}c�a r <br /> A ' " FIRE PERMIT # <br /> L <br /> INSPECTOR DATE::! <br /> ullz� jGc6' 1 ! TANK # <br /> R RINSED (Y N) METHOD <br /> I RINSE AMOUNT oto <br /> N RINSATE DISPOSAL SITE — <br /> S , <br /> E MANIFEST # <br /> -OR- OTHER _ <br /> V VAPORS PURGED -, Y/IV) METHOD <br /> A r`� <br /> ICS AMOUNT USED ` <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) L�b/� c �Z <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, OTHER) TANK SIZE.K c 1000' <br /> / 0 TANK CONDITION (GOOD, 00 ", HOLES) <br /> N '_DrraslCn' <br /> S PIPE MATERIAL (STEEL, FIRE <br /> P T ASS, OTHER) # FEET JC , <br /> I PIPING CONDITION (GOOD, POOR HOLES) <br /> N Ca rr� e V"t CLQ Q <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A - �T <br /> I N er <br /> E K T r <br /> L <br /> D EXCAVATION SIZE: r <br /> S � X ,� X Ili YDS OF SOIL: 1/? <br /> I A <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <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. : /f�Pnem�e FT <br /> N SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: Ij <br /> N I f_'_ VOLUME: <br /> ., <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />