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PHS-EHD '- UNLR ND TANK CLOSURE/ABAND(7� INSPECTION <br /> ,(SHADED AREA FILLED IN FOR THE FIRST TANK ONLY) <br /> ri 6i <br /> OWNER NAME Cly /c OWNER PHONE # ©,�•�rS'-fib 3✓ <br /> E <br /> N CONTRACTOR ©i/ F a z` Sv CON. PHONE# ,2o q - 7- <br /> E <br /> RSJLH <br /> PERM 1 T # r►tooistt.�d EPA # FIRE PERMIT <br /> q. 3 <br /> L <br /> INSPECTOR C, pl. DATE TANK N 39 - _..�sa'� <br /> R RINSED OD'N) METHOD �/,., '/� RINSE AMOUNTZ� <br /> 1 <br /> N RINSATE DISPOSAL SITE Nom` Celp A.4 <br /> S <br /> E MANIFEST -OR- OTHER <br /> V -VAPORS PURGED ) AMOO <br /> METHOD �� UNT USED <br /> A <br /> P L. E.L. READING AT REMOVAL (MUST BE ( 20%) ,-/,?o o•Z 50*O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ffTEM FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, OOR HOLES) <br /> N <br /> '.�. S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> i <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A i <br /> I - N /w <br /> E K <br /> L <br /> D EXCAVATION SIZE: X W XYDS OFSOIL: 4� <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I oat 4 Ic 1.0.14 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH D I MENS I ON ,_„_ X X YDS OF SOIL <br /> I <br /> N 2 DEPTH TO G. W. r FT SAMPLING METHOD iS <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LA80RATO RY: SAMPLERS NAME: -- <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> -H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />