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PHS-EHD - UNDERGOND TANK CLOSURE/ABANDONMEV INSPECTION <br /> (SHADED AREA TO BE[y(/FILLED IyN//y FOR THE FII�R�yST TANK ONLY) <br /> OWNER NAME OWNER F'HONE # <br /> V r <br /> N CONTRACTOR ���irr CON. PHONE# <br /> E <br /> R SJLHD RMIT # EPA 4 <br /> APERMIT # <br /> ' FIRE /ag3� <br /> INSPECTOR <br /> (f_ DATE jl�jy��`Y TANK # 39 <br /> R RINSED Y/ ) METHOD <br /> I fn /F S ,�� RINSE AMOUNT <br /> NRINSATE DISPOSAL SITE G 9,4/S• EF <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) F METHOD <br /> A , l ccs AMOUNT USED <br /> p L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEE` FIBERGLASS, OTHER) # FEET <br /> P T <br /> 7rOc� <br /> I PIPING CONDIIII (GOOD, 'OOR )HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> I A - S./4-.-.-lCr v' iC ,'Lb^ . /d,l NO-I('7C' N <br /> N <br /> E K <br /> L <br /> D EXCAVATION SIZE: �_ X X <br /> g YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P I <br /> p L p v. s <br /> E I E <br /> C N <br /> TG TRENCH DIMENSION X X _ YDS OF SOIL_ <br /> lOU c(3 <br /> --._ <br /> H DEPTH TO G. W, : FT SAMPLING METHOD <br /> N 2 S <br /> --- - Inl a 35 �i./a ei <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORRTORY: r` /7 : SAMPLERS NAME: � ��� /cud r�t- <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: , <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />