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PHS-EHD - UNDERGRMND TANK CLOSURE/ABANDONME: INSPECTION <br /> (SHADED AREA TO FILLED IN FOR THE FIRSTWNK ONLY) <br /> r--�%�c�,7iYv.�/1�C/,�ir'�DiS7/i.+✓.,�i�D'Y'/i,moi,.dO.sS�, r,r�/i,!Y/iii,�i�r�i�ADtY�'/,�O� i.��i,/�",lrX'/i,K/''�JX/,ai/ /,i4/�i./,'>'/�i�Ya'�,7/f.� �.;�f/4ii,� <br /> lvmwww ,iv r wwar�uwwwrururuwruwwwwwruwwwwi v <br /> �1 i c (YH:(�� �L �I�LWs�rLu�j ruwiaiulawiuiurawiuiurui•�wtr!{iuwr/ui/vruruGiiiwwry <br /> -' A' n/G/ T /q�/P/ X62 c`- [o✓i3G L<�/> ' <br /> OWNER NAME OWNER PHONE # <br /> C4s¢/Ps <br /> CONTRACTOR, CON. PHONE# , <br /> ysi- r <br /> R SJLHD PERMIT # EPq # r <br /> C(tOCb7r5r8Y FIRE PE/RMI # Z -Q� <br /> L GG ! ✓rt r� - uSr� r <br /> INSPECTOR DATE <br /> Z TANK # 39 - 165-7 131 <br /> 3 - �- 9 <br /> I RINSED (Y N ) METHOD �t RINSE AMOUNT as <br /> IC t S <br /> N RINSATE DISPOSAL SITE <br /> S �; <br /> I E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD AMOUNT USED <br /> I A P <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) �L 3 le <br /> 0 <br /> qT R COMMENTS (oOK v 4 srl zti e d;'5- gn Site- , <br /> N I TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE I <br /> K C <br /> / I 0 TANK CONDITION (G00 POOR, HOLES) <br /> ::` iiSE,tE?i N v <br /> I <br /> P I T PIPE MATERIAL S ESL, IBERGLASS, OTHER) # FEET <br /> I I I PIPING CONDITION (GOOD, OOR HOLES) <br /> N <br /> G I T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F <br /> I N a6 S z <br /> c K <br /> 3 <br /> D i I EXCRVATION SIZE: -,J? X ZE X YDS OF SOIL: <br /> IS <br /> I l A DEPTH SOIL TYPEI OBSERVATION SAMPLE # <br /> N M P <br /> S P I Fn c / I <br /> P L P n <br /> E I E <br /> C N I <br /> II G TRENCH DIMENSIONL X X YDS OF SOIL <br /> 0 I H DEPTH TO G. W. : FT I SAMPLING METHOD <br /> N i o / <br /> D I # OF HOURS SINCE DEWATERING: <br /> j 0 OTHER SAMPLE: <br /> I1 LABORATORY: �r Ln SAMPLERS NAME: B ! <br /> CLOSURE IN PLACE I MIXTURE: I VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE , <br />