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PHS-EHD - UNDERGR*D TANK CLOSURE/ABANDONMENOINSPECTION <br /> �f( (SHADEyD� AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ✓ ur 2f/� c '7�/�! �_ �crN Sf/cam ' <br /> � , OWNER NAME OWNER F'HONE # <br /> E �U Pf Li fc7n �U� - S3 077/ <br /> N CONTRACTOR �r�ticr CON. PHONE# <br /> E Cm�rS <br /> RSJLHD F'F RMIT # EPA 004 / FIRE PERMIT # <br /> A y .3 � <br /> L / <br /> OUL <br /> INSPECTOR DATE // �� TANK # 39 - l� <br /> R RINSED ((Y/N) METHOD 5 <br /> 75�Y� RINSE ' AMOUNT6Q <br /> N RINSATE DISPOSAL SITE <br /> S �T <br /> E MANIFEST # -OR- OTHER <br /> AVAPORS PURGED l(YYN) METHOD C�rYr« AMOUNT USED/ <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE 5/ CTU U <br /> K C <br /> / 0 TANK. CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET >ioo"oc <br /> P T c)7' s�ir/cti <br /> I F'IF'ING CONDITION (GOOD, OOR HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A sc i> To G rtJ <br /> I N oul 5 <br /> E K. <br /> L <br /> D EXCAVATION SIZE: 2--o X �Q X �. YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION ; SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E ''i. rsic /„,r//fe riu/e Gz GPoa.� <br /> C N <br /> T G TRENCH DIMENSION Xo_2(� X oZr YDS OF SOIL <br /> I <br /> 0E(ill <br /> DEPTH TO G. w. FT SAMPLING METHOD // <br /> N # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: KarrPo r4n � � .rc. <br /> � SAMPLERS NAME : IL16.y w koVur4— <br /> CLOSURE IN PLACE MIXTURE; VOLUME: <br /> EH 23043 ( I0/89) DRAW SITE MAF' ON REVERSE <br />