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PHS-EHD - UNDERGOND TANK CLOSURE/ABANDONMLO INSPECTION <br />(SHADED AREA TO BE FILLED 114 FOR THE FIRST TANK ONLY) <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />0 <br />Is <br />a 1, u u r""Gi it r i iYi"rT y��rlff Ju�ir r u it /v r <br />E <br />OW EE2 N ME C <br />J <br />OWNER PHONE # <br />T <br />N <br />E <br />CONTRACTOR p�s'r <br />CON. PHONE# <br />l <br />R <br />A <br />SJLHD PERMIT # EPA # FIRE PERMIT # <br />L <br />INSF'ECTOR'I <br />DATE N a <br />TANK # 39 <br />R <br />I <br />RINSED(Y/N) METHODS��� RINSE AMOU T' <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y N) <br />METHOD 1 G� <br />AMOUNT USED (/„ <br />K� <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST R ( 20%) D <br />COMMENTS �e L <br />T <br />A <br />R <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK S1 E <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR OLE ) 0 „� CoQ 2ro( ay�a <br />N <br />ked �v1 <br />yl <br />`r <br />S <br />F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />T <br />DEPTH SOIL TYPEOPSERVRT <br />Ot{ SAMPLE # <br />F <br />A <br />� `5 <br />I <br />N <br />E <br />K <br />Yt0 d Gls P <br />L <br />D <br />EXCAVATION SIZE: X X _ YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />-G <br />TRENCH DIMENSION X ffyX <br />YDS OF SOIL <br />I <br />0 <br />H <br />DEPTH "f0 G. W. FT <br />SAMPLING METHOD <br />N <br />2------ <br />C) <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE: <br />LABORATORY: �LLC`C'1r24 SAMPLERS NAME: L`UZ <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />0 <br />Is <br />