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PHS-EHD - UNDERGRr"'ND TANK CLOSURE/ABANDONME' INSPECTION <br /> (SHADED AREA <br /> TO�µ/py�yFILLED <br /> IN,y/�FOR yTHE <br /> F`II�YyR/SpyTp''y(�,ytNKpy O,yN�LY�) y[y( <br /> •� ( ��ly;—" 1 �7L16 'rD1v�71i7bLv�17r.W/kfvtG r FI j�S;,�ylfid'"_'_�16111%7irlb.Jilv�ly""lu'y � �rl /a <br /> E OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E CON- PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A ' ' <br /> L <br /> INSPECTOR <br /> DATE r�/�2 Z r- <br /> R RINSED �N) METHOD RINSE AMOUNT 300 <br /> N RINSATE DISPOSAL SITE uoy{y <br /> S ` <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (LY)N) METHOD <br /> A AMOUNT USED„r��0 �6 <br /> P L. E. L. READING AT REMOVAL (MUST BE ( EUX) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MA'fERIgL TEE FIBERGLASS, OTHER) TANK SIZE vrPu <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET - <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A /6 C I Fo o r eo% oN <br /> IN /< ` s. <br /> oc✓a^ rsto b <br /> E K ou f <br /> L <br /> rscs/o C <br /> D EXCAVATION SIZE: 12, YDS OF SOIL ; <br /> S /e�Cl r/S c/S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P - SAMPLE # <br /> S P I - <br /> F' L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH "f0 G. W. : FTSAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: f �oL r SAMPLERS NAME: <br /> �t(Ae rfVA*.J <br /> CLOSURE IN GLACE MIXTURE: VOLUME : <br /> EH 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />