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PHS-EHD - UNDERC , jUND TANK CLOSURE/ABANDONMm_wgT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> BN"6"y"u,"� "4"�"6"Y �"' <br /> OWNER NAME U 0 � OWNER PHONE# / ,y- _ 63/D <br /> E <br /> N CONTRACTOR 5 �� ` CON. PHONE40/4) 11 7�7q-.2 <br /> E �7 <br /> R SJLHD PERMIT # EPR # 20 FIRE PERMIT <br /> '' '. //// /r <br /> INSPECT DATE) Z TANK # 39 <br /> R RINSED (Y NY METHOD (r �Ce (�FNS� RINSE AMOUNT /SV <br /> I I <br /> N RINSRTE DISPOSAL SITE PpcT , )6-y, �FIt,/�2(eS T <br /> S <br /> E" MANIFEST # _— _ -OR- OTHER <br /> V VAPORS PURGED (Y/N) NEI-HODI AMOUNT USED /G6 <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) D <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE,"/Oo <br /> K C /rte <br /> / O TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T o IN <br /> F R <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: z_ X i X : YDS OF SOIL : <br /> S <br /> I RDEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P - 17 <br /> S P I V f 1 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL_ <br /> I —' -- <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: 1111a z"va.li{ <br /> 0 OTHER SAMPLE: <br /> LABORATORY: Lv SAMPLERS NAME :�XflR ( es <br /> CLOSURE IN PLACE MIXTURE: VOLUME : <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />