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A 5bs <br /> PHS—EHD — UNDERGI-o.UND TANK CLOSURE/ABANDONME,.- INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �rx�ana�ac� xa�aarax� rzra�c / xa � <br /> %/ �.Yr�law�.l�r,��`urarpwrawwru ruurwwwwraarwwww rr u�v� �v� /OD wwwiuwiu urury ruurr�rp/u�G��� rbw <br /> OWNER NAME OWNER PHONE # <br /> E Ce S. 1� b 4/1,7 3 - �3/ <br /> N CONTRACTOR /t/� /f- � CON. PHONE# 369_ y�d5 <br /> E w is <br /> R SJLH PERMIT # /I� /� EPA # !opo" FIRE PERMIT #1? �8 <br /> A ,q c�x <br /> L K i /r <br /> INSPECTOR ary! 16W- I DATE 11 1_100/0/ TANK. # 39 <br /> R RINSED (Y/N) METHOD( r!(� RINSE AMOUNT 6� <br /> I <br /> I l <br /> NRINSATE DISPOSAL SITE r - YpeRt b} <br /> I! S <br /> E MANIFEST # 3 51(o -OR- OTHER <br /> i <br /> V VAPORS PURGED Y N) METHOD AMOUNT USED 5b�6S <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) La,� ) <br /> 0 1" <br /> T R COMMENTS <br /> "um ( p <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N / <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, 0 HOLES),'Svne Pvidy ncsp� Pros oti <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T U Q/rn°F /�® . <br /> F A „ _ <br /> I N 0odl7K or <br /> � <br /> E K N A — ill <br /> L <br /> D EXCAVATION SIZE: 12,VX r X r � YDS OF SOIL: <br /> S <br /> Z/ yi3— <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P Q <br /> S P I <br /> F' L P ci <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 2 <br /> 0 # OF HOURS SINCE DEWATERING: ro weoW lCcsllYt <br /> OTHER SAMPLE: <br /> O❑ <br /> LlLABORATORY: �j SAMPLERS NAME: p <br /> CLOSURE IN PLACE MIXTURE: N VOLUME: <br /> H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />