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PHS-EHD - UNDER#'JND TANK CLOSURE/ABANDONMI$; INSPECTION <br /> (SHADED AREA TL BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ✓P:inu. F �/�i�.s , ,a.r w• F' d..tm �z�P Sfv�Ce�- <br /> � , OWNER NAME OWNER GHONE # <br /> E �, F / s/� - 9s/ - YGsy <br /> N CONTRACTOR CON. PHONE# <br /> E Go mr Fx« f%t 707 37V- <br /> A .F SJLH PERMIT # Epp 4 <br /> A FIRE PERMIT 0, <br /> / <br /> L 4 <br /> INSPECTOR <br /> DATE /013013/ TANK # 39 <br /> R RINSED (YN) METHOD <br /> I �. RINSE RMUUN7 <br /> // <br /> N RINSATE DISPOSAL SITE j <br /> S G'! /C. S✓t-7 /! Gc..0 .�(t �z,a%,'S ?�it�. <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED CY/N) METHOD AMOUNT USED <br /> A �Ec :C �U�Lis�c•� y; <br /> P L. E. L. READING AT REMOVAL <br /> 0 (MUST BE ( AUX) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ' (STEELy FIBERGLASS, OTHER) TRN�, SIZF7 <br /> K C //� f <br /> c�t,y <br /> / 0 TANK CONDITION (GOOD, FYo_A-. HOLES) <br /> N <br /> S PIPE- ( -BERGLASS, OTHER) # FEET <br /> p T /V -'-yam <br /> I PIPTNr. rnnnrT <br /> N (GOOD, POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F <br /> E K <br /> L <br /> D EXCAVATION SIZE: �o d <br /> S 1► X YDS OF SOIL: 2j :� j -?4o <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M cfC ` (J SAMPLE # <br /> S F' <br /> Ip L <br /> sc e. 1 <br /> E I <br /> iC N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> i I — — <br /> 0 H DEPTH TO G. W. FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ! /r S SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: / VOLUME: <br /> :H 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />