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PHS-EHD - UNDERG &ND TANK CLOSURE/ABANDONMI• INSPECTION <br /> (SHADED AREA TUE FILLED IN FOR THE FIRST TANK ONLY <br /> � , OWNER NAME - J7WNER PHONE # <br /> E rnd. f / YG3f� e <br /> N . CONTRACTOR CON. PHONE# <br /> E GO/y fx Cud 7v7 37Y- ��Pi <br /> R .F SJLH PERMIT # EGA <br /> A CArooue✓Sy FIRE PERMIT # cf/ p�� 3 <br /> L 4 <br /> INSPECTOR DATE / <br /> R RINSED (Y�)' METHOD <br /> I /%=� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE 2 / <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A � )MOUNT USED <br /> P <br /> L. E. L. <br /> O L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> � <br /> A T R COMMENTS <br /> N TANK MATERIAL ISTEELJr FIBERGLASS, OTHER) TANK 917P <br /> K C �G <br /> / 0 TANK CONDITION (GOOD, <br /> N P00 , HOLES) <br /> S FIGS <br /> T rpscL�� -zBER£LASS, OTHER) # FEET <br /> P <br /> I <br /> PIP TN� rnninrrr <br /> IV �--------^---- (GOOD, POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T _. SAMPLE # <br /> I N <br /> E <br /> K <br /> L <br /> D EXCAVATION SIZE: �o <br /> S )f'/7- X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M �' < �t� SAMPLE_ # <br /> S p <br /> E <br /> C N '--- <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT -7� <br /> N SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: w� „ � .i�.yi 'cz�;a SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE. <br /> VOLUhIE: <br /> 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />