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PHS-EHD - UNDER �DUND TANK CLOSURE/ABANDON,, T INSPECTION � J <br /> ,yD�/ AREA, l/ $E ��/X��ED Y N FOR <br /> (SHADETHEj F I RNT <br /> TANK ONLY) <br /> OWNER- NAME �- OWNER PHONE # <br /> ' <br /> E � r�h� Cedvc.h�r ,r 1 0 - y(.Gr32- <br /> N CONTRACTOR <br /> E s G✓G s Ger. �37e 4� CON. PHONE# 7Y/��-G <br /> R / SJLH PERMIT # mon j 3. � EPA # <br /> ' <br /> A - ! FIRE PERMIT # 13 Al <br /> L ' <br /> INSPECTOR G', 07__ DATE 5-141/9 TANK14 39 - s -7/ <br /> R RINSED C'N} METHOD <br /> RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # "" °f <br /> { -OR- OTHER <br /> VAPORS PURGED �N) METHODy <br /> A �y3a AMOUNT USED. <br /> - <br /> P L.'E. L. READING AT REMOVAL (MUST BE ( 20%) D <br /> 0 Z= c__Z ' <br /> T R COMMENTS <br /> TANK MATERIAL TEE <br /> K C , FIBERGLASS, ❑TREK) TANK SIZE <br /> TANK CONDITION (GOOD, '00 HOLES) <br /> N <br /> :, S PIPE MATERIAL STEE , FIBERGLASS, OTHER} )# FEET <br /> P T <br /> I PIPING CONDITION (GOOD, P'OOF2 HOLES) <br /> N i <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T j SAMPLE # <br /> A <br /> I N <br /> � r <br /> ` LE <br /> E K �� lLL N� 3 <br /> L se/ <br /> D S EXCAVATION SIZE: �O �}{ O 'X 13yDS =l F SOIL: �� 3 <br /> T q <br /> DEPT OIL TYPE OBSERV ON <br /> N M P SAMPL # <br /> S P I <br /> P L p <br /> E I E i <br /> C N <br /> ii <br /> T G TRENCH DIMENSION X <br /> I XYDS OF S <br /> O H DEPTH TO G. W. : '. <br /> N 2 _ FT SAMPLING METHOD 4 <br /> � <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: F� r <br /> i� "Jj ;S VYJry GTM !lK �y1- A <br /> LABORATORY: w�����`4 Cf� <br /> SC rl viceSAMq'LE RS NAME: "1 <br /> �Y-�e <br /> CLOSURE IN PLACE MIXTURE: ` <br /> � � ivyr <br /> _7H 2:.0�r3 ( 10/89) VOLUME. <br /> SITE MAP ON REVERSE '1 <br />