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PHS-EHD - UNDE-71ROUND TANK CLOSURE/ABANDOi *TNT INqpEC XON <br /> (SHADED ARE BE FILLED IN FOR THE FI TANKk NL , -� <br /> FNP S, ra, k4cc Lino <br /> OWNER NAME } �� OWNER PHONE # 'ZO9` �yaZ-I�lz <br /> CONTRACTOR CON. PHONE#�Oq_ �y- <br /> rrK:v <br /> RlSJLHD PERMIT # EPA # '' FIRE PERMIT # 3z <br /> A <br /> L <br /> INSPECTOR DATE 6 TANK # 39 - ...x. 1.2_ <br /> R RINSED( ) METHOD .h RINSE AMOUNT <br /> I :arc <br /> N RINSATE DISPOSAL SITE 4e <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGE (Y ) <br /> -A METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C 1Z cloo An, <br /> . <br /> / 0 TANK CONDITI (GOOD, DOR, HOLES) <br /> N <br /> i S PIPE MATERIA (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOODS POOR, HOLES) <br /> N <br /> G <br /> T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F Aff= AJO <br /> I N <br /> E <br /> L <br /> D EXCAVATION SIZE: X ?L X (L YDS OF SOIL: <br /> S � 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 JH DEPTH TO G. W. : FT SAMPLING METN # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> ' LABORATORY: Q 7 SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME:' <br /> EH 23043 (10/69) DRAW SITE MAP ON REVERSE <br />