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PMS—EHD — UNDERGRJ TANK CLOSURE/ABANDONM INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST Tit-ONLY) <br /> 90 <br /> OWNER- NAME <br /> I LL L RO /GS OWNER PHONE <br /> N CONTRALTON AM 644 So NS CON. PHONE* <br /> E — 0 <br /> R SJLHD PERMIT # EM <br /> A FIRE PERMIT #lei <br /> L <br /> INSPECTR DATE2—,/f_9/ TANK # .?,9 <br /> R RINSED (Y/C)) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A G AMOUNT USED <br /> 0 L.£. L. READING AT REMOVAL (MUST B ( 20%) L <br /> 4'4-- <br /> T <br /> T R COMMENTS �{ <br /> A /.r <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE S � l <br /> K C <br /> f TANK CONDITION (G �F- <br /> NOOD, P <br /> S PIPE MATERIAL STEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N f; wAA bkt,dt,.� S <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A W O S arc <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S ILX 12-ZXf— T YDS OF SOIL:— <br /> OIL: Drs <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 /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> ' LABORATORYs o SAMPLERS NAMC: <br /> 'a <br /> CLOSURE IN PLACE MIXTURE: M VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE ` <br />