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PHS-EHD - UNDERGF.�-IND TANK CLOSURE/ABANDONME�i.�, INSPECTION <br /> (SHADED/ AREA TO BEFILLED <br /> IyN� FOR THE <br /> ���,yFIRST <br /> �y�TANK <br /> ONLY) <br /> 1� z, Z _ lr"7i%vi16XrklliJri7lik'ryli� z �YA 0( <br /> 9537 ? . <br /> E <br /> OWNER-,&6&__ <br /> G ss OWNER PHONE # 7 – <br /> N CONTRACTOR ' CON. PHONE# 0 <br /> R SJLHD PERMIT # 28� /2� FIRE PERMIT # G� Z <br /> .:1 <br /> INSPECTqpDATELI=IZZD TANK # 35 <br /> R RINSED (Y N) M-THOU RINSE AMOUNT 35 <br /> • I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD AI4OUNT USED O <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL ((STEES <br /> . FIBERGLASS, OTHER) T NK 12 <br /> / 0 TANK CONDITION OD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ( TEE �F_IBERGLASS, OTHER) # FEET <br /> P T '\� <br /> I PIPING CONDITION (GOOD, �OOR, HOLES) O pW ��N� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T (14 <br /> F A 0 <br /> I N <br /> E K <br /> L <br /> D EXCAVATION" SIZE: S X X f7_ YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I Vc C <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X — X YDS OF SOIL <br /> I __ <br /> O H DEPTH TO G. W. : _ FT_T� SAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING: /j/v <br /> O OTHER SAMPLE: <br /> LABORATORY: F G SAMPLERS NAME: �G <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 231043 (10/89) DRAW SITE MAP ON REVERSE <br />