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PHS-EHD - UNDEfti:' 1 TANK, CLOSURE/A9ANDONM. S NSPECTION <br /> (SHADED AREA-�T-O-PE'F I LLED IN FOR THE F I RSI TANNK ONLY) <br /> ol <br /> is .wra,t�i[uru�.raj!!�lrrrurufdiuirrruruiurumw.cvrvw.rvrut+riuuruacuru r urrr �r411ruurrurureiuiviuruivrur�ru rfra.crr�irrru r,��u�vrurra�cvruru <br /> OWNER NAME OWNER RHONE # <br /> } z � <br /> E <br /> N . CONTRACTOR CON. PHONE# 7OZ.)�3 j 3.7j7 <br /> E " <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # ozo , <br /> L � r r diG ti ra c G it���G G /r <br /> 1 <br /> INSPECTOR �� DATE 4f ]°J�,cf TANK # 59 .-- � - � �- <br /> R RINSED (Y/N)/t/ METHOD A11A- RINSE AMOUNT f <br /> I <br /> S RINSATE DISPOSAL SITE <br /> Sail <br /> E MANIFEST # -OR-a OTHER <br /> i V VAPORS PURGED Y)N) METHOD V)& AMOUNT USEDr®91af5 .. <br /> P L. E. L. READING AT REMOVAL; (MUST BE < 20%) <br /> ' 0 <br /> T R COMMENTS <br /> A <br /> N TANS: MATERIA c FIBERGLASS, OTHER) TANK SIZE,%ooO <br /> K C <br /> / 0 TANS'. CONDITION (GOOD,- OLES) <br /> N <br /> S PIPE MATERIAL TES FIBERGLASS, DTHER) # FEET <br /> P T ' <br /> I PIPING CONDITION (GOOD, P�6�HOLES)�. <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION . SAMPLE: # <br /> T •� <br /> I N C!D �� c1 r�• t r Z �� <br /> E K <br /> F� <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OSSERVATION `; SAMPLE # <br /> N M P <br /> a <br /> S P I - <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 1 O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: y <br /> fOTHER SAMPLE: <br /> LABORATORY: ' SAMPLERS NAME: <br /> CLOSURE IN P --- - <br /> LACE MIXTURE: _ � � VOLUME: <br /> H 23043 (10/89) DRAW SITE MAP ON REVERSE <br /> d <br />