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RHS—EHD -- UNDERGND TANK CLOSURE/ABANDONM* INSPECTION <br /> (SHADED AREA TD E FILLED IN FOR THE FIRST TANK ONLY) <br /> vL� ��. . i�v �� r err f <br /> .` <br /> OWNER- NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR . 1. DATE TANK # 39 -- — <br /> r <br /> R RINSEDY N) METHOD H h. � RINSE AMOUNT <br /> I `_ <br /> N RINSATE DISPOSAL SITE p [[.MSS} <br /> S CST <br /> E MANIFEST # —OR— OTHER <br /> A VAPORS PURGED t /N) METHI ELLfOD� � AMOUNT USED <br /> 0 t�Aw <br /> P L. E. L. READING AT REMOVAL (MUST RE ( 2_UX) ���''/Q Z = 'Oro <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C ____50OL-) <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> .' S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) It FEET c <br /> P T <br /> NPIPING CONDITI GOOD POOR, HOLES) .Sft// �o <br /> G T DEPTH SOIL TYRE OBSERVATION SAMPLE # <br /> F A r <br /> c7 <br /> I N <br /> E K t-,, 4--", '" <br /> D S EXCAVATION SIZE: X � X YDS OF SOIL: <br /> I A DEPTH/ SOIL TY OBSERVATION SAMPLE # <br /> N M p <br /> S P I ' <br /> P L P <br /> E I E <br /> C N <br /> T G TRENC DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H BERTH TO G. W. - ' v FT SAMPLING METHOD N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 ❑THER SAMPLE: �} <br /> LABORATORY: *00la_ SAMPLERS NAME <br /> CLOSURE IN RLACE MIXTURE: NI�� VDLUPIE: <br /> H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />