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PHS-EHD - UNDERAUND TANK CLOSURE/ARANDONME11- INSPECTION <br />(SHADED AREA TO RE FILLED IN FOR THE FIRST TANK ONLY) <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />iia %ii�/// z/ ffi i/Iu �. r'�ii r� r u r a <br />f <br />E <br />OWNER NAME- <br />a u c -7� � <br />OWNER F'HONE # <br />N <br />CONTRACTOR 0 <br />CON. PHONE# <br />E <br />R <br />A <br />SJLHD PERMIT # EPA # <br />61 <br />FIRE PERMIT # <br />1,ril <br />L <br />INSPECTOR ��� u <br />DATE 1�3p �y <br />TANK # 39 - �- - OLo-zp ..'- <br />R <br />I <br />RINSED &/N) METHOD RINSE AMOUNT lJD <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED(�Y%N) <br />'F <br />METHOD <br />AMOUNT USED s' <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD,(F'00 , HOLES) / <br />feel <br />N <br />Az)yjSilJ�pµOc�q. <br />P <br />S <br />T <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I <br /># FEET <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A <br />I <br />N <br />+ S aM S 6 n GCN.( uvL <br />E <br />K <br />S C <br />L <br />EXCAVATION SIZE:. X I3 X <br />YDS OF SOIL: <br />D <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 />TRENCH DIMENSION X X <br />YDS OF SOIL_ <br />T <br />G <br />0H <br />DEPTH TO G. W. FT <br />SAMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE: <br />LABORATORY: L(' Imo . <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />