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PHS-EHD - UNDEF, ( 1UND TANK CLOSURE/ABANDONN, ,.T INSPECTION <br /> (SHADED AREA Tt3' BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER- NAME,7C OWNER PHONE # f <br /> NCONTRACTOR 5 f)eM u�-! � CON, HONE# <br /> E 7 t[ �� <br /> R . , SJLHD PERMIT # EPA # FIRE PERMIT <br /> L <br /> � . <br /> INSDATE f (� +�'-SIO TWNK # 39 - .. 01 <br /> R RINSED (Y/ ) METHOD �tINS <br /> I E AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S '` <br /> E MANIFEST ## -OR-- OTHER <br /> V VAPORS PURGED (Y N) METHOD 1 Ge AMOUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST B ( yG ) 3u� O z ' o <br /> c �c <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA TEE. , FIBERGLASS, OTHER) TANK SIZE 1QQa� <br /> K C <br /> 0 TANK CONDITION (GOOD, POOR HOLES) <br /> S PIPE MATERIA TEFL, FIBERGLASS, OTHER) # FEET <br /> P T 1J�'S <br /> I PIPING CONDITIO GOOD, POOR, HOLES) <br /> G D PTH SOIL TYPE OBSERVA ION <br /> T fork SAMPLE # <br /> FA <br /> I N ! <br /> E K <br /> L <br /> j 4s <br /> D E AT I ON Z E: x � x YDS OF SOIL: T '� <br /> S <br /> I A DEPTH SOIL TYPE QBSERVATION <br /> N M P SAMPLE`## f�, <br /> S P I <br /> P L P L <br /> E I E t <br /> C N Y k <br /> T G TRENCH DIMENSION l 5 xJ <br /> I ._ x YDS OF SOIL bay <br /> b <br /> O H DEPTH TO G. W. : _ _ FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: JC!Zy/,Y1pCly. 11 /�S fsyi SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> ZH 23043 ( 10/89) DRAW SITE MAP ON REYE --*'t <br /> D� <br />