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FHS-EHD - UNDERG TANK. CLOSURE/ABANDONMENSPECTION D <br /> tSHADEll APER TO RE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER RME ' AM OWNER PH DNE # �C <br /> O <br /> N CONTRACTOR /�� G� �r .!/` CON. PHONE# — <br /> E V, C T to <br /> R SJLHD PERMIT # EF'� Z X97 FIRE PERMIT iNAN <br /> .Q� �� , <br /> A <br /> L <br /> INSPECT DATE TANK Ch TANK # 39 <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE (r- <br /> S tt <br /> E MANIFEST # -OR- OTHER <br /> VV VAPORS PURGEDN) METHOD D� � AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> R FKoS e <br /> N TANK. MATERIAL (STEEL) FIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / 0 TANK CONDITIOND, F'OOR, HOLES) of <br /> N /" Z " <br /> S F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEkT/� <br /> R T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: Z X /SX -7 YDS OF SOIL: <br /> S <br /> I A DEFT SOIL TYPE OBSERVATION SAt4PLE # <br /> N M R <br /> S R 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 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0OTHER SAMPLE: �RRN K pt( A <br /> LABORATORY: SAMPLERS NAMF�: <br /> i <br /> CLOSURE IN F'LACE MIXTURE: VOLUME: <br /> =H 23043 (10/89) DRAW SITE MAR ON REVERSE <br /> r <br />