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PHS-EHD - UNDERGR�D TANK CLOSURE/ABANDONME*INSF'ECI-101\1 <br /> (SHADED AREA TO FE FILLED IN FOR THE FIRST TANK ONLY) <br /> "FT <br /> s # j, I <br /> E OWNER NAME _ OWNER PHONE # -)39 a ;7/ <br /> E CONTRACTOR f C` 45 k ( & CON. PHONE# <br /> - d0y - <br /> R SJLHD PERMIT # EPA # FIRE PERMIT #,,fl'5 <br /> p , <br /> INSPECTOR �1 �� <br /> DATE / TANK # 39 <br /> R RINSED (9N) METHOD : s �rr f2INSE AMOUNT 7 SS�cII MS <br /> N RINSATE DISPOSAL SITE <br /> S II/� G� /9e lCrc,Ie, u <br /> E MANIFEST # i� -OR- 07HER <br /> V VAPORS PURGED tqN) METHOD /' AMOUNT USED <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST RE ( 20%) S <br /> 0 <br /> T R COMMENTS it <br /> A <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE /D 64 <br /> I{ C / / /c5e -/ <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL S' EEL FIBERGLASS OTHER) # FEET i <br /> P T _ �/ <br /> I PIPING CONDITION (GOOD, F OR, HOLES) <br /> N <br /> G I- <br /> I <br /> H SOIL TYPE OBSERVATION SAMPLE # <br /> 1'F R N ' ,r ., „ „ A) <br /> E K <br /> L <br /> D EXCAVATION SIZE: 3D X 3jj� X ' YDS OF SOIL :ti OQ Q/ s <br /> S <br /> I A DEPTH SOIL_ TYPE OBSERVATION SAMPLE <br /> N M F' <br /> S F' I 3j ,st /(J74�,o 47 <br /> P L P <br /> E I E 3+4' �l w 3 <br /> C N <br /> T G TRENCH DIMENSION :/S X c?� X I' YDS OF SOIL <br /> I - vyd3 <br /> 0 H DEPTH "f0 G. W. : — — FT SAMPLING METHOD Btass �tS <br /> N 2 <br /> # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: C' r�74a/ �p! Sf� SAMPLERS NAME : F" <br /> /moi a�1y <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />