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PHS--EHD — UNDE 'JND TANK CLOSURE/ABANppN <br /> (� (SHADE,yD�/ YARE A � E 'FILLED I N FOR THE FIRS, ANKSONLY) ON ' <br /> sa1'�ii��i�'�,�Ja��i%a� (JIf��Er:tv'7/i7�i�irtiYirJ�l�r:�lil'.�iu <br /> E OWNER- NAME OWNER PHONE # 07 <br /> N CONTRACTOR 'r <br /> E cf-IsA IaNk CON. .PHONE#` 6.2 S - r <br /> R SJLHD PERMIT # <br /> EPA #�qpl, FIRE PERMIT # r�329ff <br /> A , r <br /> L r �i <br /> INSPECTOR DATE TANK # 39 — <br /> f L6 <br /> R RINSED (Y/N) rya aMETHOD RINSE AMOUNT <br /> I hCrr <br /> N RINSATE DISPOSAL SITE y <br /> S Clef!-'o., I w rSo� t'R <br /> E MANIFEST # --OR— OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A ; AMOUNT USED <br /> P L.E.L. READIN AT REMOVAL (MUST BE < ;��,;�)' �t as )0"- A— <br /> 0 <br /> T R COMMENTS , <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) ° TANK SIZE fitl1p- <br /> K C <br /> / O TANK CONDITION ' GOOD POOR, , HOLES) <br /> N a <br /> S. . <br /> +" S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET s <br /> i P T } <br /> I PIPING CONDITION (GOOD, POOR, HOLES) p w„ <br /> � N <br /> w G DEPTH SOIL TYPEOBSERVATION <br /> T SAMPLE # <br /> F AI11 aCb �, <br /> E N � o � lG-%-! <br /> 't L K <br /> EXCAVATION SIZE: X X � YDS OF SOIL: —2S— <br /> DEPTH <br /> � <br /> S z S— o <br /> I A DEPTH SOIL TYPE . OBSERVATION SAMPLE # <br /> N M P �s .. <br /> S P I 1' Ati <br /> P L P Igoe <br /> ' <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YD <br /> f I S OF SOIL <br /> O H DEPTH TO G. W. : 7 <br /> FT SAMPLING METHOD <br /> N ? `_ <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER- SAMPLE.- <br /> LABORATORY: <br /> THERSAMPLE:LABORATORY: � SAMPLERS NAME: , yrs- � -3-k m/t�nr�,r� Lubs 1 S <br /> CLOSURE IN PLACE MIXTURE: , <br /> VOLUME: <br /> H 2-043 ( 10/84) DRAW SITE MAP ON REVERSE <br /> as <br />