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PHS-EHD - UNDERI 'ND TANK CLOSURE/ABANDONN INSPECTION <br /> (SHADED AREA TOLE FILLED IN FOR THE F I RST"ANF'. ONLY) <br /> I <br /> lG �iYl/rJ('/�/iXl/rf.U/Xi/r�,</�' '/✓ryC/�'/XG/,�/i�/i!U,Y�/r!,!/rYi/rt' r�ryf/rX�/r�r�'/iY;/iY.'✓rY�/�.G/3�';f1�3�r�/h'C��/rY.Ur�!/i3'✓rs4:#!/�!/�':'y:/�,y�r�iX'/rt�rY,v" <br /> /u� cru [Ev vrurcvruia raraiuruarrurvrur urruurar uiu wiui rr r�r SW rrrirr uiuiuiuiuiuiuiaarruiur Warr r�iuiirw irr/1 <br /> ururriar <br /> OWNER NAME OWNER PHONE # % <br /> N CONTRACTOR <br /> CON. PHONE# <br /> E <br /> R SJLHPERMIT # w�6�Y d <br /> EPA FIRE PERMIT # <br /> INSPECTOR G�4 DATE _ 31- ' <br /> TANK, # G9 <br /> R RINSED CJ/N) METHOD �r le RINSE AMOUNT <br /> iy <br /> N R-INSATE DISPOSAL SITE //�I '7c�$ ✓t�dreEs <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHODy ice AMOUNT USED <br /> A 304'5 <br /> P L. E. L. READING AT REMOVAL (MUST RE < 20%) <br /> 0 - D — <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTEE � FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, (F§ HOLES) <br /> N <br /> X S PIPE MATERIAL FIBERGLASS, OTHER) # FEET , <br /> P T Pio <br /> I PIPING CONDITION (GOOD, PO HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION . SAMPLE # <br /> T S o7/disw�ri u <br /> F A Su��r' Clu i o -7-K r r <br /> � i <br /> I N <br /> E K ' s a.t��clu � '/�/" <br /> L <br /> D EXCAVATION SIZE: elO X YDS OF SOIL: y��3 <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 CH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD / <br /> N 2 �/Lr S 5 fLr�S <br /> 0 # OF HOURS SINCE DEWATERING: <br /> LOTHERSAMPLE: <br /> 1[:LABORATORY: SAMPLERS NAME:� � G �� or <br /> � y <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />=H 23042 ( 10/89) DRAW SITE MAP ON REVERSE � <br />