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PHS-EHD - UNDERGRO' 'D TANK CLOSURE/ABANDONMEN- '.NSPECTION <br /> /(SHADD AREA TO FILLED IN[/ FOR THE FIRST 1" K O�ytNJLLj/Y//) <br /> 1 1 wm b m/ % '4 ' <br /> ht, .> v!CC Fi D�/.2 E kei1G uu✓ Leer.(, <br /> OWNER NAME OWNER PHONE # <br /> E S -ZO7 -3`34-2-737-2- <br /> N <br /> 3`.34-2'3'2N CONTRACTOR CON. PHONE# <br /> E tva ter;v;C-0- ff Mfuhg4A All? <br /> R SJLHD PERMIT # EPA # Ntt FIRE PERMIT # �* <br /> A <br /> L <br /> INSPECTOR C �I v7^ I DATE s-4 TANK # 39 (3a � <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD N ( AMOUNT USED <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE N� <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET N <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) A/LJ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T , <br /> F A ^� o src for to % <br /> E K <br /> L <br /> D EXCAVATION SIZE: L X X YDS OF SOIL: " 30 dS <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 XYDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: , <br /> LABORATORY: A44,vj i,,tb SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> _H 23343 ( 10/89) DRAW SITE- MAP ON REVERSE <br />