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PHS-EHD - UNDERGOND TANK CLOSURE/ABANDONMEO INSPECT -101'4 <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />..�rr�oomimiimrraramrrrmrrirra'vvnmirauruvuiivi.�//,Y//X//x//M//MU.Y//.fU/MUX//N//NGN//N//H1/N//6I/XUr1Y/HUNUNOr)1/ifl/iY4iil/iY.�iY�i,�i%�iS.�/i�/i�r%(!!�'i <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />r e a <br />OWNER NAME [ OWNER PHONE # CoZO q Jai J6 i <br />T <br />E <br />N <br />CONTRACTOR CON. PHONE# <br />E <br />R <br />SJLHD PERMIT # EPA # <br />FIRE PERMIT # <br />A <br />WN <br />L <br />N10-- <br />INSPECTORSF DATE /0/3/ g'l <br />Lo <br />TANK # 39 <br />R <br />RINSED (Y N)' METHOD RINSE L OUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (Y)N) <br />METHOD <br />AMOUNT USED a� ✓� <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST 20%) <br />T <br />0 <br />R <br />COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIA TEE , FIBERGLASS, OTHER) <br />TANK SIZE <br />/ <br />O <br />N <br />TANK CONDITION (GOOD, POOR, HOLES) <br />/ trC <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />F <br />A <br />I <br />E <br />N <br />K <br />[4SAMPLEj#T <br />L <br />D <br />kip <br />EXCAVATION SIZE: X Z X -T <br />YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />P <br />L <br />P <br />-- <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />0 <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />C� <br /># OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: F �- I <br />SAMPLERS NAME: <br />Li"F <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />