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4 ?oma 3 <br />PHS-EHD - UNDE ROUND TANK CLOSURE/ABANDOI*ENT INSPECTION / <br />Vy(SHADED �AREATO BE FILLED IN FOR THE FIRST TANK ONLY) <br />EH 2-3043 (10/89) DRAW SITE MAG ON REVERSE <br />v_/fFC <br />OWNER NAME <br />E P- NA r� rrt <br />OWNER PHONE # <br />og-Zg0-6 S3j, <br />N CONTRA TOR <br />E V/.QO M6�.1?l�}L N <br />CON. PHONE# LIIF- p -7 <br />L Qa — / `7/—ISD <br />RSJLHD PERMIT # EPA #Zt432-] FIRE PERMIT # <br />L <br />INSPECTO DATE TANK # <br />I z <br />R <br />RINSED (Y/6 METHOD Ptlm ed 6V7' <br />RINSE AMOUNT <br />I <br />d w <br />N <br />RINSATE DISPOSAL SITE <br />S <br />r -A7-re-z SJR <br />E <br />MANIFEST # _ -OR- OTHER <br />V <br />R <br />VAPORS PURGED Y N) <br />METHOD D R� SGS <br />AMOUNT USED <br />P <br />O <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) — — 6 I2eb* Gt�lu} <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIRL ( TEEL FIBERGLASS, OTHER) TFiNK SIZE�j <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />N <br />,se''ti <br />S <br />PIPE MATERIAL ( TEEL FIBERGLASS, OTHER) <br />I it FEET $ <br />P <br />T <br />_ <br />I <br />PIPING CONDITION (GOOD, POOR, CHOLES <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SA PLE # <br />T <br />F <br />R <br />Ire Q <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X _LZ -X <br />YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATIONSR PLE # <br />N <br />M <br />G <br />S <br />F' <br />I <br />F. <br />L <br />P <br />2 <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X�., X o2 <br />YDS OF SOIL <br />I <br />' <br />0 <br />H <br />DEPTH TO G. W. li(k !_ FT <br />SAMP L I NG METHOD <br />N <br /># OF HOURS SINCE DEWATERING:G <br />0 <br />0 <br />0 <br />OTHER SAMPLE: <br />LABORATORY: ROG n /✓A7Lit -]„c, - <br />SAMPLERS NAME: <br />CLDSURE IN PLACE MIXTURE: VOLUME: <br />EH 2-3043 (10/89) DRAW SITE MAG ON REVERSE <br />