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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDCNMENT i.NSPECTION <br /> (SHADED AREA TO 3 =ILL_] IN FOR THE FIRST Tf ONLY) <br /> � 4JPJYJdJ4JRWJldUJ4J!/J4J4J6'/i,51 !!f!J!/ /JIlot%Y/!0'ATY{Y/Y4//J!/lIJdII//YJ/%/dl V%4JJlGLY4'LY////Jlf!/Ji//0'JJfff% <br /> OLIO I }IluLi t <br /> ^L(5 n 1-ILUzl)U7 ' 5)0' <br /> OWNER NAME OWNER PHCNE <br /> N OCNTRACTOR I CON. PHCNE# <br /> R SSLHD -RMIT # EPA # FIRE PERMIT # <br /> l4 w•u.1 <br /> A nGiG / <br /> L uua rG Sr LG rG �' /G1liLt <br /> K t VM V � l.�u Urt— Lt N N G � ICl R rtT "Li rt"- I <br /> i <br /> I <br /> INSPECTOR DATEg(�� ` TANK # 39 <br /> R I RINSED /N) I METHOD lC RINSE AMOUNT <br /> N RINSAT£ DISPOSAL SITE ILI� <br /> c MANIFEST # -OR- OTHER <br /> V VAPORS PURGED �Y N) I METHCD f �C I AMOUNT USED ��h <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) phi <br /> 0 <br /> T ! R COMMENTS <br /> A <br /> N TANK MATERIAL E_1 , FT.BERG LASS, OTHER) I TANK S17= Zo 0 0 <br /> K C <br /> / ! 0 ! TANK CONDITION (GOCD, OCR HOLES) <br /> N ' <br /> `. I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S ! i DEPTH I SOIL TYPE I OBSERVATION I SAMPLE # <br /> T I 54 >J utas <br /> F A I nD vd�vl sc1-47 t <br /> S4 /oGw t <br /> I I i N I t <br /> = K <br /> L <br /> D j EXCAVATION SIZE: X /S X L' I YDS OF SOIL: Sa <br /> S <br /> I ! A DEPTH I SOIL TYPE I OBSERVATION SAMPLE # i <br /> S P ! I I I <br /> P L P I I I <br /> E I E <br /> C N 1 I <br /> T GTRENCH DIMENSION X X YDS OF SOIL �� Yr( 3 <br /> I <br /> 0 H DEPTH TO G. IW. : FT I SAMPLING METHOD 4�rc sr �t (mss <br /> j 0 ! # OF HOURS SINCE DEWATERING: <br /> I <br /> 0 OTkER SAMPLE: <br /> i <br /> LABORATORY: L ! SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: I VOLUME: <br /> H 2 O+.i (10/89) DRAW SITE MAP ON REVERSE . <br />