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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONME' 'NSPECTION <br /> (SHADED AREA p;TyC���}�y jFILLED IN FOR THE <br /> FIRST',, .,.,4K ONLY) <br /> lr�K-O PE�5 � fa �2 , ON�D �' GIS 376 •{! <br /> OWNER- NAME OWNER PHONE <br /> � <br /> N ! CONTRACTOR_ CON.�,11�L-x-PIL- CON. PHONE# 'i <br /> R S.TLHD PERMIT # EPA # 1fq FIRE PERMIT # J *3 <br /> L r '� 7 r%y� •y <br /> 70 <br /> J <br /> INSPECTO DATE + _� TANK # _39 <br /> I RINSED t Y N) METHOD-7y R I NSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD �� AMOUNT USED <br /> A S <br /> P L.•E. L. READING AT REMOVAL (MUST BE <br /> 0 <br /> T R COMMENTS �-jjw <br /> A svl�H� <br /> N TANK MATERIAL STEEL. FIBERGLASS,_OTHER) TANK SIZE <br /> K C Zao c? <br /> / O TANK CONDITION (GOOD, POOR, OLES �� <br /> N y- / <br /> s �� $ ei``�ai✓� 1 <br /> • S PIPE MATERIAL TEEL, FIBERGLASS, OTHER) # FEET e- 2 ✓ ` <br /> P T J•�-� TLu^�i� <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F <br /> E K <br /> L <br /> D EXCAVATION SIZE: /Z <br /> S X �_ X � YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION i <br /> N M P SAMPLE # r� <br /> S P I \ �O <br /> P L <br /> E I E �p <br /> C N <br /> T G TRENCH D I MENS I ONx x <br /> YDS <br /> �,/i `� \ <br /> I OF SOIL <br /> ►v) <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> to # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLURIE <br /> 22,043 ( 10/89) DRAW SITE MAP ON REVERSE <br />