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PHS-EHD - UNDERGfb-JND TANK CLOSURE/ABRNDONMEIr INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> , . <br /> �Y �"y"y ,"y,,,,"y"Y"6�Yy VA' , "y "y� "�"y I <br /> OWNER NAME ( SC� OWNER PHONE # <br /> E <br /> ECONTRACTOR �,� Q,'G CON. PHONE# -20 � <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # _Q a <br /> A <br /> L <br /> INSPECTOR-rI;gs DATE l l a. i f'q TANK # 39 d L <br /> R RINSEDY N) METHOD O G �� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # _ -OR- OTHER <br /> V VAPORS PURGEDY1N) METHOD AMOUNT USEDa� <br /> A <br /> P. L. E. L. READING AT REMOVAL (MUST R < 20%) <br /> 0 <br /> A R COMMENTS Dec d <br /> l rnu , V�e <br /> �M <br /> K C TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK S ZE �r/q�f W <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) ,_ ,. �- / p <br /> N ✓"��//�C e { 0 <br /> S F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N _ <br /> E K Ouym Z <br /> L C0 a44= I <br /> VJi y�v` <br /> D EXCAVATION S E: X X S YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <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. F=T SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SRMF'LE: <br /> LABORATORY: C. L A: SAMPLERS NAME :Ll <br /> CLOSURE IN PLACE MIXTURE: VOI..UME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />