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PHS-EHD - UNDERI*UND TANK CLOSURE/ABANDONAT INSPECI-1011 <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �""f"o"8g "�"f,"y" � ��"Y�"�,,;, <br /> OWNER NAME OWNER PHONE# <br /> E No �� s' <br /> vtoy -�36 �3i?S <br /> N CONTRACTOR 61j 55FT7 / (STS` CON. PHONE 1/6) q6 -7�f C�i, oAL <br /> E ( o c oo zo p r7 <br /> R SJLHD PERMIT # EF'A # FIRE PERMIT # 0 -Dy/ D i <br /> A �� <br /> L <br /> INSPECT DATE 2 TANK # 39 <br /> /' (p <br /> R RINSED (Y N METHOD( -Ce RlNS� RINSE (1MUUNT /Sv <br /> I (" <br /> N RINSATE DISPOSAL SITE P'�-r �Ly)6-y, �e��i✓e2feS T <br /> S <br /> E MANIFEST # _ -OR- OTHER <br /> V VAPORS PURGED (Y N) METHODDic - � AMOUNT USED �Ud <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2i1%) O <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK S1ZE.,%OD <br /> K' C i Cv� <br /> / 0 TANK CONDITION (GOOD POUR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A O <br /> I N D <br /> E K C' <br /> L <br /> D EXCAVATION SIZE: X i X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> S P I I^ G L_�:: r? 71-F �.. , , . . <br /> P L G <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X __. X YDS Uf= SOIL <br /> I <br /> 0 H DEPTH TO G. W. : _�� FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: to <br /> 0 OTHER SAMPLE: <br /> LABORATORY: LL -T�Pf1 SAMPLERS NAME-,,,,C es <br /> CLOSURE IN PLACE MIXTUREIIii: VUL.UME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />