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PHS-EHD - UNDE�ROUND TANK CLOSURE/ABANDOtv'7�)ENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAMEU O� GkL �f - OWNER PHONE # I <br /> E <br /> N CONTRACTOR di-JQLFIpCON. PHONE# <br /> E �y!y <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # 1 .j C)5 <br /> A <br /> L /I / <br /> INSPECTOR [ ,-I DATE //3 TANK # 39 - <br /> R RINSED (ON) METHOD-M"*:57 0-1ASE RINSE AMOUNT <br /> I d <br /> N RINSATE DISPOSAL SITE stn FNVIIQDN�/�IFN <br /> S f � <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED JON) METHOD ppyAMOUNT USED <br /> R 540110s <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20;C) (EZ�- 16 _ <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALEE - FIBERGLASS, OTHER) TRNK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, F HOLES) <br /> N <br /> S PIPE MATERIAL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, R OLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A W •p n <br /> I N <br /> E K <br /> L �1q <br /> D EXCAVATION SIZE: X Z X 104 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 <br /> C N <br /> T G TRENCH DIMENSION X X VDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />