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PHS-EHD - UNDERGILD TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO RE FILLED IN FOR THE FIRST TANK ONLY) <br /> w lo.1ial <br /> EE OWNER NAME OWNER PHONE # <br /> X39 -ate <br /> E CONTRACTOR Q U f - CON. PHONE# <br /> _C'o_ fv_u4 aS9`1 3S -a S J <br /> R SJLHD PERMIT # EPA # <br /> A FIRE PERMIT ajP�sj <br /> INSPECTOR C UL DATE / / TANK # 39 - <br /> R RINSED y N) METHOD <br /> I 4 -/per S u RINSE AMOUNT f <br /> N RINSATE DISPOSAL SITE WKS <br /> S Ol df <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (CY, METHOD <br /> A hY Fce AMOUNT USED ,/2S 1�S <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 204) 7Ko%c.z '' < C <br /> Wu S CTHI�t'n 7. '• <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( EE FIBERGLASS OTHER) c/G <br /> K C ' + TAN SIZE <br /> / 0 <br /> TANK CONDITION OOb, POOR, HOLES) <br /> N <br /> • S F'IF'E MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T y� <br /> I PIPING CONDITION (GOOD, - 'OOR HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T _ SAMPLE # <br /> F q <br /> I N <br /> /orG /i <br /> E K <br /> L <br /> D EXCAVATION SIZE: _�iy X 3 <br /> S X <br /> /� YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION o <br /> N M P SAMPLE <br /> S P I <br /> P L P - - <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION yX o2' X /' <br /> IYDS OF SOIL <br /> � <br /> 0 H DEPTH TO G. W. : F=T SAMPLING METHOD <br /> N 2 ----- - �fGss �c. <br /> C) # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: < a/ �r�y <br /> C-- y Yxv✓, is SAMPLERS NAME : Tjsn <br /> CLOSURE IN PLACE MIXTURE: ter, <br /> VOLUME: <br /> EH 23043 ( 17/89) DRAW SITE MAI-' ON REVERSE <br />