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PHS—EHD — UND -ROUND TANK CLOSURE/ABAND ENT INSPECTION <br />(SHADED ARE O BE FILLED IN FOR THE FlWT TANK ONLY) <br />� �nE'"IV�N(ry��rukYrYlvla�l/iJ.v'7u�:Gi'.Zi,iay��i""7uy�i'iIiy�v�'Jli 77.v ��JJ;;��;; �ia'7L'7�Ylv�i��'7/i7uyliYily� NffS,,yy�yyi/rf��7y/i/il�"Ju7/r7Ji r <br />/cTT <br />. <br />H lc[DRJ212 E �'"f"^ lop <br />�, •y OWNER NAMEPHONE # <br />E Cv.vf <br />N CONTRACTORS• S S CON. PHONE# <br />E114 <br />R SJLHD PERMIT # EPA # FIRE PERMIT # /3 ObG <br />k� <br />L <br />J J <br />INSPECTOR �N•fi <br />DATE <br />TANK # 39 S <br />R <br />RINSED ( /N <br />METHOD <br />RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />MANIFEST # —OR— OTHER Errcksvv 3 5 <br />E <br />V <br />VAPORS PURGED (Y ) METH0Dp� AMOUNT USED <br />A <br />� J . <br />P <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) -- <br />0 <br />COMMENTS <br />T <br />R <br />R <br />- <br />N <br />TANK MATERIAL (STEEL FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />(%('n <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />N <br />Cc fh <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET y/ <br />P <br />S <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A <br />/ d <br />I <br />N <br />f) <br />E <br />K <br />L <br />D <br />((// <br />EXCAVATION SIZE: X �O X YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SA PLE # <br />N <br />M <br />P <br />- - <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF: SOIL <br />I <br />_" _ <br />O <br />G. FT <br />SAMPLING METHOD <br />N <br />SINCE DEWATERING:LLE:'arn�rp <br />jejjjE <br />`;�5 <br />SAMPLERS NAME: Cv��fP✓LMIXTURE: <br />VOLUME: <br />EF <br />0.043 (10/69) DRAW SITE MAP ON REVERSE <br />