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PHS-EHD - UNDERG*D TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �, �afa�d ncsn /S/S lll. 5 •l <br /> OWNER NAME�� j��US Ay <br /> i E <br /> E6:, <br /> CONTRACTOR J� 16b s II/ 3/ J 3-3&�7 t <br /> l.�t CDN. F HONE# (O <br /> R SSLHD PERMIT # N (k EF'A #GAC p / <br /> A 2 Z32 FIRE PERMIT # �?j�(oZ no <br /> L u ui r <br /> INSPECTOR (}N� L DRTE S Z� TANK # 39 - _ _ <br /> I RINSED N) METHOD( <br /> l OUNT <br /> ' RINSATE DISPOSAL SITE Demo <br /> � KC'rabbn <br /> �! MANIFEST # -OR- OTHER I <br /> AV VAPORS PURGED (Y N) METHOD/-��� AMOUNT USED S (6 S <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20X) < �eJ D9( l eL <br /> O (° L <br /> T R COMMENTS Y� <br /> A !o-M <br /> N TANK MATERIALi (STEEL, FIBERGLASS, OTHER) TANK SIZE Z�/� <br /> K C <br /> / 0 TANK CONDITION (GOOD, PDDR, )HOLES) <br /> N <br /> S PIPE MATERIAL (STEE9, FIBERGLASS, OTHER) # FEET n <br /> P T <br /> I PIPING CONDITION (GOOD, <br /> N POOR, HOLES) .fYM ( ,Q A <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A - l' San. 0 CL M P9( ISLe Orrt <br /> I N 3 CK is�lorz ;cw <br /> E K <br /> L <br /> D EXCAVATION SIZE: fD X � X o IQ <br /> S L YDS OF SOIL: � �� 5;,It aKew <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P. I <br /> P L P ti <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 SA METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> nO <br /> OTHER SAMPLE: V� <br /> LJLABORATORY: SAMPLERS NAME: I'I 6n <br /> CLOSURE IN PLACE MIXTURE: N VOLUME: U <br /> H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />