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PHS-EHD - UNDERGROUP TANK CLOSURE/ABANDONMENT� �SPECTION <br />(SHADED AREA TO B6.FILLED IN FOR THE FIRST TAhTK ONLY) <br />i�G/NG.YHX/I.G/XLCY//.MMYYNYNYNYNYMYMrr/w...u..0............. .. <br />n r L+tr - l/fly <br />OWNER - NAME <br />N CONTRACTOR <br />E ✓ __ ><� �coN SNe <br />R SJLHD PERMIT # EPA <br />T <br />A <br />N <br />K <br />b -Y6 -/, l?,re&&u. I - - ' ' C <br />OWNER PHONE # <br />O9 56 9'AcDq <br />CON. PHONE# <br />'Z oq_ yy 3- 7/OfJ <br />FIRE PERMIT # j 3`7'75" <br />—---......� .,, r-�,..� _• i LMP'Or7A(7Y""CL"0'CC�ft'C'.Yw,,,,/..vw.�w�rw <br />INSPECTOR C,Htitifi DATE TANK # 39 _ /5 1 7 <br />R RINSED N) METHOD <br />I /�rPssu� l.L_1 RINSE AMOUNT <br />N RINSATE DISPOSAL SITE <br />S Aoll.rp Seru��s <br />E MANIFEST o w -OR- OTHEf <br />V VAPORS PURGED ( N) METHOD <br />A PR 1Ce_ <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20X) <br />0 <br />R COMMENTS <br />C TANK MATERIAL STEEL, FIBERGLASS, OTHER) <br />0 TANK CONDITION (GOO , POOR, HOLES) <br />N <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />T DEPTH SOIL TYPE OBSERVATION <br />A <br />N . <br />K <br />AMOUNT USED <br />TANK SIZE <br /># FEET <br />WE <br />SAMPLE # <br />;t _ /e <br />rr_ Q L1 <br />EXCAVATION SIZE: YQ' X X YDS OF SOIL: <br />S <br />A DEPTH SOIL TYPE OBSERVATION <br />M P SAMPLE # <br />P I <br />L P <br />I E <br />N <br />G TRENCH DIMENSION X _ X YDS OF SOIL <br />H DEPTH To G. W. : <br />` FT SAMPLING METHOD <br />U # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: r SAMPLERS <br />itlP:knG/JY/roN:nFn,%� Sur.te c TP•i, , A <br />CLOSURE IN PLACE MIXTURE: <br />_ VOLUME: <br />23043 (10/89) DRAW SITE MAP ON REVERSE <br />/Z'k /lipst% <br />