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PHS-EHD - UNDaROUND TANK CLOSURE/ABANDD�NT INSPECTION <br /> (SHADED AREA TO BE FILLED IN yFOR THE FIRyyS((�yTTANK <br /> �yONLY) <br /> �1t 7(�iti�7Jli7iil'YYJi iLrrY rYi r � r d r iJ <br /> , <br /> OWNER NAME OWNER PHONE # A <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # �5!;2-q FIRE PERMIT # g1-DOZ- i <br /> r r <br /> L <br /> INSPECTORge, [� — DATE gjII TANK # 39 _-_ o <br /> R RINSED 6?N) METHOD�P /�I S� RINSE AMOUNT �Z64L <br /> I <br /> N RINSATE DISPOSAL SITE /Q -F-,I FffF�SS <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED -&YIN) METHOD C�; y 16,F- AMOUNT USED /AS <br /> A ToP oFT/aN C Tb o 0 A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) g Z <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE �5�U 64L- <br /> K C <br /> / O TANK CONDITION (GOOD, t HOLES) <br /> N ._ <br /> S PIPE MATERIAL FIBERGLASS, OTHER) # FEET L�P- <br /> P T � --� <br /> I PIPING CONDITION<IhE d, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A 7 A49 0 0 5oi� dr5� Tid 6s- rP-� /z <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: h� X ��x ` r YDS OF SOIL: p ,mac <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : _ FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: 1541 1EA SAMPLERS NAME: 5p5jW AAV/Gir—t <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />