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PHS—EHD — UNDERGR!1UND TANK CLOSURE/ABANDONME `NSPECTIZ <br /> (SHADED AREA /IT,,��'�/, yFILLED <br /> IyN�/ FOR THE <br /> FIRST%ei..,K ONLY) <br /> / r .IUO��� :Zd�1L1 lvi�Q ;i�rly lli 1L :r[�i y' F Al <br /> 2 <br /> DOWNER NAME OWNER PHONE # /j <br /> F art— o F , l.I�r'Z0 fl 20 9— 8'3S-x''79 0 A <br /> N CONTRACTOo e i �, <br /> E / G CON. PHONE# j � I <br /> 'i <br /> �SJLHD PERMIT # EPA FIRE PERMIT <br /> J I.r I�U J <br /> INSPECT R DATE]/—/ ) TANK # <br /> R RINSED Y4N) METHOD ( __-- <br /> I _ (,� �,us�o R I NSE AMOUNT ` r <br /> i N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> I —OR— OTHER <br /> V VAPORS PURGED Y N) METHOD Q� <br /> A te_ AMOUNT USED `-7 <br /> P L.E. L. READING AT REMOVAL (MUSTBE ( �GX) any= D <br /> O It� <br /> T R -COMMENTS _ 12 <br /> A e U N L-&� <br /> N TANK MATERIAL STEC , FIBERGLASS, OTHER) TANK SIZE <br /> K c 2p <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) 3 <br /> • S <br /> P T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION •OOD � POOR, HOLES) _ <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T � k S p SAMPLE # <br /> F A A- J;j , r l2 O Uv <br /> E K <br /> L <br /> D EXCAVATION SIZE: '� <br /> S � X X � YDS OF SOIL <br /> I A DEPTH SOIL TYPE OBSERVATION / <br /> N M SAMPLE #i <br /> S P % <br /> P L r0 v✓ ''/ <br /> E I <br /> C N <br /> T G TRENCH DIMENSION <br /> I X YDS OF SOIL <br /> 0 H DEPTH TO G. : <br /> W. • <br /> N -=---..— FT'�" SAMPL I NG METHOD <br /> U # OF HOURS SINCE DEWATERING: � � � <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> joZLCCGQ �f- SAMPLERS NAMC: <br /> CLOSURE IN PLACE MIXTURE: / <br /> VOLUhIL <br /> 3::043 (10/89) DRAW SITE MAP ON REVERSE <br />