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PHS-END - UN �k,_AOUND TANK CLOSURE/ABA' N, <br /> h►tNT INSPECTION <br /> (SHADED A TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 5-f <br /> E OWNER- NAME s/,g OWNER PHONE # , <br /> N CONTRACTOR�#3ClLf <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # C-"MAPR" coo <br /> A "�-iS'3 FIRE PERMIT <br /> L # �3� <br /> i <br /> VHL 11 <br /> INSPECTOR �.� -' j LDATE �s(Z TANK # 39 <br /> R RINSED (Y N) METHOD <br /> I RINSE AMOUNT — <br /> N RINSATE DISPOSAL SITE <br /> S r <br /> E MANIFEST <br /> -OR- OTHER <br /> V VAPORS PURGED YN) METHOD <br /> A Ice AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE ( EGX) <br /> 0 ©z =5�/0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (SS_jF,Et, FIBERGLASS, OTHER) I TANK SIZE <br /> / 0 TANK CONDITION 0 , POOR, HOLES) <br /> N Cu`I-E�OCA t Ci <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET ,� <br /> P Tt rGwlc- <br /> I PIPING CONDITION (COOD,� POOR, HOLES) <br /> N >T)LL. w'IG•4E'?� <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A GOA-w� Sr T- <br /> I N <br /> E K <br /> L2 <br /> D EXCAVATION SIZE. <br /> S � -io X -� X ;:9 YDS OF SOIL <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 D I MENS I ON X :X ,__ <br /> I ^.,, YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; <br /> N E -- -�--._ FT SAMPLING METHO� ting.-j(P dip <br /> 0 # OF HOURS S I NCE DEWATERING: j 2 U <br /> 0 OTHER SAMPLE: <br /> LABORATORY: C,4L WAr67Z- SAMPLERS NAME: M"-' 77 r'� <br /> CLOSURE IN PLACE MIXTURE: / <br /> �/ VOLUME: 7 <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />