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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT NSPECTION 3 F <br /> (SHADED AREA TO E FILLED IN FOR THE FIRST TpioK ONLY) i <br /> k�a✓rAu� K <br /> E •% OWNER NAM pll <br /> l. OWNER PHONE # <br /> N '! CONTRACTOR CON. FHONE# i <br /> E ' <br /> R F SJLHD PERMIT # X00 FIRE PERMIT # <br /> ` ..,, , <br /> INSPE T46� DATED _ TANK # 39 <br /> R RINSED Y ) METHOD -S RINSE AMOUNT /� p <br /> N RINSATE DISPOSAL SITE A <br /> �� <br /> S Pi(-1 rti <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ( N) METHOD ox ZG� AMOUNT USED <br /> A OD <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) U)y S,s <br /> D FL = <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEEf <br /> P T <br /> I PIPING CONDITION (GOOD <br /> N POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A d A/W <br /> I N O/ <br /> E o <br /> K <br /> D EXCAVATION SIZE: Y <br /> S � X 3� X .Lv YDS OF SOIL: S� <br /> I A DEPTH S L TYPE OBSERVATION <br /> # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> O H DEPTH To G. W. : <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: tqA L\ &AV SAMPLERS NAME: <br /> M, <br /> CLOSURE IN PLACE MIXTURE: <br /> V OLUhIL <br /> H 2_1,043 ( 10/A9) DRAW SITE MAP ON REVERSE <br />