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a FHS—E:iD — UNDERGROUND TANK CLOSURE/ABANDGNMFNT INSPECTION i <br /> (SHADED AREA T ._r lE FIL:.LED IN FOR THE FIRS A 'ANK ONLY) <br /> zO <br /> 1J!l,JU�/f,/-!y!/!!!/!Uf!%1!//!J!!J!/!/f/IU!//IU.U/ SIL L K �.7�y2 2/" / v!//!!/I!/J!/Ji/ lUI'J!//�!!U/J/�/IL /lrJUlf/W <br /> C 51 I C fil �V/`C/� ! Tlij7 f� rSfl7j I (fJ/`//i- �j <br /> j OWNER NAME OWNER PHONE E oN f Udl 4rz(X�) ZZ—oz <br /> N CONTRACTOR �-fCD CON. PHONE# <br /> I E , <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> S <br /> of ,G 'YOG1lrilr�f1G <br /> L i lGvl�l� E�G� ry uS�utt 1� *T 'GrC�irt/ � <br /> INSPECTOR ��� DATE 7� cj� TANK # 39 — — <br /> f <br /> F R R I NSED YI) 1 METHOD IPlp <br /> f /� RINSE AMOUNT <br /> I # 71 <br /> N RINSATE DISPOSAL SITE <br /> IS I <br /> E MANIFEST # -OR— OTHER <br /> V VAPORS PURGED ON) METHOD QQ [ � AMOUNT USED <br /> AF. <br /> R L. E. L. READING AT REMOVAL (MUST BE < EO::) <br /> 0 i U <br /> T R COMMENTS <br /> A <br /> N [No TANK MATERIAL TEEL, IBERGLASS, OTHER) TANK SIZE <br /> K <br /> / TANK CONDITION (GO ORHOLE'S) <br /> PIPE MATERIALIBERGLASS, a'.HER) # FEET <br /> PI PIPING CONDITION (GOOD, POOR., HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # J <br /> LI <br /> F C ( /� o cci r ea I S'zr� I <br /> I I r2 -, it ,/0'1 Qtz c <br /> fL i <br /> A EXCAVATION SIZE: X X I YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE I OBSERVATION SAMPLE # j <br /> N M P ! ' <br /> S P I I i <br /> P L P <br /> I' E I E <br /> c N I I <br /> T G TRENCH .DIMENSION X X YDS OF SOIL <br /> E I <br /> I 0 I H DEPTH TO G. W. : FT � SAMPLING METHOD <br /> N 12 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> E0:11 <br /> I LABORATORY: SAMPLERS NAME: <br /> FCLOS URE IN PLACE MIXTURE: I VOLUME: I <br /> i <br /> EH 2-204:, ( 10/89) DRAW SITE MAP ON REVERSE <br />