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PHS-EHD All UNDE JUND TANK CLOSURE / ABAND04NT INSPECTION <br /> U - ( SHADED AREA * BE FILLED IN FOR THE FIRST TANK ONLY ) <br /> w _ <br /> OWNER NAME OWNER PHONE # <br /> E //w �v9 - 5Yy div R <br /> N CONTRACTOR <br /> E <br /> R SJLHD PERMIT # EPA # <br /> A esssbv FIRE PERMIT # /3 SS S <br /> L <br /> INSPECTOR CIO DATE TANK # 39 - ( yt� - Cit/ <br /> IRINSED ((JN ) METHOD ` - /e ` RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED 6y / N ) METHOD <br /> A AMOUNT USED <br /> P L. .E . L . READING AT REMOVAL ( MUST BE < 20% ) <br /> 0 <br /> T R COMMENTS <br /> A wjAAl <br /> N TANK MATERIAL ( 81EELAI FIBERGLASS , OTHER ) TANK SIZE /i <br /> K C <br /> / 0 TANK CONDITION <br /> N ( GOOD , OOR HOLES ) <br /> S PIPE MATERIAL TEE FIBERGLASS , OTHER ) # FEET <br /> P T <br /> I PIPING CONDITION ( GOOD , POOR , HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A ' / o A <br /> I N ANN . r c� <br /> E K <br /> L <br /> D EXCAVATION SIZE : � X 7' X S / <br /> S YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <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 /> ❑ H DEPTH TO G . W , : FT <br /> N 2 SAMPLING METHOD <br /> � ss X61 d <br /> U # OF HOURS SINCE DEWATERING : <br /> III 0 OTHER SAMPLE : <br /> LABORATORY : <br /> FGG SAMPLERS NAME : � Gr� <br /> CLOSURE IN PLACE MIXTURE : <br /> VOLUME : <br /> .H 23043 ( 10 / 89 ) DRAW SITE MAP ON REVERSE <br />