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PHS-EHD - UNDERGROV- ) TANK CLOSURE/ABANDONMENT NSPECTION <br /> (SHADED AREA TO L"lFILLED IN FOR THE FIRST T,�< ONLY) <br /> /��rrirr,i�'/rrX'/�xi,�a/ . %lIL,YG/,�f/;�!r§!�D /�°0"li�!/i�/. i,Yl�i,N/iQ!'✓, '/i�/N/ /�Tlit4'/,W / %i'1/ l�iYlill/,rU/�}f/�Y,�f!it'i/ irrGf/%Yl/i <br /> 51 iat�iV iii)4r�ta.�riuraraiuruiu�uruiuwruurairuiuruiuru cacvrarr�try+urw ,ra�jraiuiaiucriuiaiarr/i✓iuiuiv ffrjr wam"mP/-"r aruiuruw <br /> L b-r -k tel' '--'w4a u u t 3-1/3v E1 0. s ,.> <br /> OWNER NAME . OWNER PHONE # <br /> E pa '24-n-On" I —l.?`!S— <br /> N CONTRACTOR CON. PHONE# 3 <br /> E ( '" <br /> R SJLHD PERMITr # EPA #CAccW,'raaz FIRE PERMIT # I(/J � <br /> y(/_�/�� <br /> L <br /> f TANK # 39 - /0 8 7 <br /> INSPECTOR DATE <br /> c. HuNf 616 7/ <br /> R RINSED ON) METHOD J5 asA RINSE AMOUNT-,,gS <br /> I <br /> N RINSATE DISPOSAL SITE r' <br /> S Re-tINP Irv' is P ,✓ c <br /> E I MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHOD AMOUNT USED <br /> A �0 4b <br /> <f <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> a <br /> V TANK. MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> 'A C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ( TEEL FIBERGLASS, OTHER) # FEET,, <br /> P T <br /> I PIPING CONDITION (GOOD, 'OCR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T , Cy/l <br /> F A C NO O�c'" NO Miro l p� (aN <br /> le, l <br /> E K <br /> L <br /> D EXCAVATION SIZE: �5/� X �iX YDS OF SOIL: .�,��-yq/s ..T <br /> S <br /> A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> I M P <br /> a P I <br /> L P <br /> 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 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O I OTHER SAMPLE: <br /> IF—LABORATORY: 6 L SAMPLERS NAME: I <br /> I CLOSURE IN PLACE MIXTURE: VOLUME: KK <br /> 2.?.cj4,3 (10/89) DRAW SITE- MAP ON REVERSE <br />