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PHS-EHD - UNDERt3 ND TANK CLOSURE/ABANDON INSPECTION 0 <br /> (SHADED AREA TO BE FILLED I N FOR THE <br /> �yFIRST TANK <br /> py�ONLY) <br /> Iq <br /> RA M ce n% a s I o W !T- , C S2o r <br /> E OWNER NAME PKR Cwt OWNER PHONE # '— c���-20 V/ , <br /> N CONTRACTO ��� �G CON. PHONE# <br /> E R a 109 <br /> AR , SJLHD PERMIT # EPA # FIRE PERMIT # '0-O S <br /> L <br /> I NSPECT DATE 1� 9� TANK # 39 <br /> RINSED Y N METHD&/— A15e-- R I NSE AMOUNT 'Z <br /> N R I NSATE DISPOSAL SITE F� IvER f/ LSa+, CA- <br /> E _ <br /> ' S/se-v yes a�i <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED YON) METHOD pr Z C L AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> te <br /> / 0 TANK CONDITION (GOOD)POOR, HOLES) <br /> N <br /> P S PIPE MATERIA (STEEL, FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (GOOD, <br /> N <br /> G eA- <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: IO X 15- X -7 YDS OF SOIL: ,Z0 .�- <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE #� <br /> N M .P <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 /> O FH <br /> DEPTH TO G. W. : ' FT SAMPLING METHOD <br /> AlN W# OF HOURS SINCE DEWATERING:OTHER SAMPLE: <br /> LL ABORATORY: G L CJI dor rV-T/k SAMPLERS NAME• k�i ��G�L <br /> CLOSURE IN PLACE MIXTURE: VOLUME: r` <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />