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PHS--EHD — UNDERF w'UND TANK CLOSURE/ABANDONI}r —T INSPECTION <br /> (SHADED AREA ', Sq.►3E FILLED I N FOR THE F I Rd_ „SANK ONLY) <br /> r--�f/�;4J��?y��fdm.�/i.�/§//�i,i�f�!i��il�/i.�!/•� ,,. ,.sf�,�i'0�°�iDd�?�, ,� , , , ,!(/�y ,�//..f,� , . <br /> OWNER NAME T OWNER PHOONE � (cu_ <br /> E <br /> N CONTRACTOR Gf� CON. PHONE# <br /> E <br /> AR � S.TLHD PERMIT # !/! EPA # � FIRE PERMIT # ���� 7:1G//i /r <br /> + L <br /> I <br /> ° INSPECTOR ��� DATE 7�7i�' 9( TANK # ::.9 <br /> R RINSED ) METHQvf A tj4prRINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> i S <br /> E MANIFEST # —OR— OTHER <br /> i <br /> V VAPORS PURGED (9N) METHOD? � AMOUNT USED,,,��5—fps <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A E <br /> N E TANK MATERIAL IS—TSE CFIBERGLASS OTHER) , TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOO ROO HOLES) <br /> S PIPE MATERIAL TEFL FIBERGLASS, HER) # FEET <br /> A 1 <br /> I I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> GI iI DEPTH I SOIL TYPE 1 OBSERVATION SAMPLE # <br /> T • t 0 iD" -4;000 <br /> I N i s r ..1, oN Nd /S to ora I L <br /> 1 <br /> E K <br /> L <br /> D LJ EXCAVATION SIZE: X X I YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> I' E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> U # OF HOURS SINCE DEWATERING: <br /> ' 0 111 1 OTHER SAMPLE: <br /> � <br /> LABORATORY: SAMPLERS NAME: <br /> LFCLOSURE IN PLACE MIXTURE: ( VOLUME: <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />