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PNS-EHD -- UNDERGR ID TANK. CLOSURE/ABANDDNME*NSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK. ONLY) <br /> �r,�v rfr,�u rrur rrr� rErr { � r riiri7761fll rr�rirliIM1iia111j,urifnur r <br /> r OWNER NAMEOWNER PHONE 7� ' <br /> Ems►` ! <br /> N CONTRACTOR )r CON. PHONE# a <br /> R SJLHP PERMIT # JIJf EPA FIRE PERMIT # ! �� <br /> A <br /> L <br /> r r TANK, # G9 <br /> INSr-'ECTOR 5 j J, DATE �► r�' �� <br /> - ��- <br /> R RINSED OYN) METHOD-�ri li-?- RINSE AMOUNT'fq C?^, <br /> I <br /> N RINSATE DISPOSAL SITE r <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED (YN) METHOD AMOUNT USED (� <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < . 20%) 1 6L'97 <br /> " <br /> 0 <br /> T R COMMENTS <br /> : A <br /> N TANK. MATERIAL (STEELS FIBERGLASS, OTHER) TANK SIZE <br /> K C - <br /> / 0 TANK. CONDITION (GOOD, j OOR,,� HOLES) SJ�h a51 <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) nc) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> T N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S - <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> 5 F' I <br /> P L p' <br /> EI E <br /> C N I r :j <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I [ I <br /> 0 H DEPTH TO B. W. : FT SAMPLING METHOD <br /> N E <br /> 0 # OF HOURS SINCE DEWATERING: I A W <br /> F711 OTHER SAMPLE; (W vv - al'k ' <br /> HiLABORATORY: 'hN�. SAMPLERS NAME:o,0 T� �L,� I�� <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 ( 10/89) DRAW SITE MAR ON REVERSE <br />