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PHS--EHD - UN Z�D TANK CLOSURE/ABANDO :NT�INSPECTION <br /> (SHADED AR� J BE FILLED IN FOR THE FI r TANK ONLY) <br /> P <br /> �.. OWNER NAME S' <br /> E 1 r OWNER PHONE # �Z09 � <br /> E CONTRACTOR <br /> CON. PHONE# <br /> R SJLHD PERMIT # CAcc�co.. A�- <br /> q. EPA # FIRE PERMIT # <br /> L 3z <br /> INSPECTOR DATE <br /> TANK # 39 <br /> R RINSED Y ) METHOD <br /> I Sym RINSE AMOUNT j <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # G <br /> -OR- OTHER <br /> V VAPORS PURGE (Y ) METHOD <br /> A cAllm AMOUNT USED f <br /> P L. E. L. READING AT REMOVAL (MUST SE < 20X) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS* THER} <br /> K C OTAW SIZE <br /> 0 TANK CONDITI (GOOD <br /> N , OR, HOLES) <br /> x' S PIPE MATERIA (STEEL, FIBERGLASS <br /> P T , OTHER) # FEET A/ <br /> I PIPING CONDITION {GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE <br /> OBSERVATION <br /> F A 3 SAMPLE # <br /> I N lovec+ <br /> E K ; Na <br /> L <br /> D EXCAVATION SIZE: � <br /> S .' .� X a` X LL_. YDS OF SOIL <br /> I A DEPTH SOILTYPE <br /> N M p OBSERVATION <br /> S P ; SAMPLE # <br /> © L P <br /> t E I E <br /> C N <br /> T G TRENCHDIMENSION <br /> I �— X X YDS OF SOIL <br /> O H DEPTH TO p, W, ; <br /> N 2 �_�_ FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> a SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: , <br /> VOLUME:, <br /> 1 2304F3 (10/89) " DRAW SITE MAP ON REVERSE <br />