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PHS-EHD - UNDERGRSD TANK CLOSURE/ABANDONMEIOINSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> •I / �rvYrYr€u �i�l(!�Evrr fu{QI uiawiuiuiui rru ur�rurufuiuur�%!6�i �r�i�r '7uw7uiuiaiuYii/ii�iur""�iriuiu �r�rr��'iir�u r rii u <br /> E OWNER NAME�fQ�'Vt' �� �✓� OWNER F'HONE # 7�5 C�rJ[�_j�s <br /> N CONTRACTOR <br /> E �b�hGS CON. FHONE# � (o3_ �3 (v3 <br /> 1 <br /> Li /SSLHD PERMIT # N 1� EPA #- '21-� r FIRE PERMIT # 137) 3 <br /> INSPECTORya,,,j�lt,�.(t DATE � I'L� q� TANK # 39 - IZ��q - /' �j <br /> RINSED METHOD <br /> MOUNTADTV <br /> RINSATE DISPOSAL SITEno OrdWh <br /> E <br /> = E-� MRNIFEST # -OR- OTHER CA-1090e) 1 335 <br /> AVAPORS PURGED (YYN) METHOD ( P.lu AMOUNT USED 2oIh j,- of 5 <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 t-1,%02- ejo <br /> AR COMMENTS Q� �A, �Y$� <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE 1y <br /> K C <br /> SW <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET LJ a <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL YF!E OBSERVAT ON SAMPLE # <br /> T 6w, 1j ac" (� <br /> F Ag ocLtY 4 SSP u' <br /> I N i <br /> E K <br /> L <br /> D S — <br /> EXCAVATION SIZE: X '�`� X C YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S F' I <br /> PL P 0V 7 <br /> E I E <br /> CN <br /> T G TRENCH DIMENSION XX YDS OF SOIL <br /> I — <br /> 0 H DEPTH TO G. W. : �3 FT SAMPLING METHOD <br /> h� <br /> N c v <br /> 0 # OF HOURS SINCE DEWATERING: W f1 S I�!?ZJS O&kAl <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: � I <br /> CLOSURE IN PLACE MIXTURE: 'I PC VOLUME: <br /> 23043 ( 10/89) DRAW SITE MAF, ON REVERSE <br />