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1 <br /> PHS — UNDER `ND TANK CLOSURE/ABANDONM INSPECTION . <br /> (SHADED- AREA �E FILLED IN FOR THE FIRST ANK ONLY) <br /> 45 <br /> y <br /> OWNER NAME OWNER PHONE # <br /> fob Aoki ' <br /> E <br /> N CONTRACTOR p� p CON. PHONE# . <br /> E lr� _��_cN tiles �r <br /> R SJLHD PERMIT # ERA #cgccoOx FIRE PERMIT # o- 03313 <br /> A - <br /> L <br /> INSPECTOR C'. j-�� ,-r DATE !ll�jgo TANK # 39 — 60 .. r :. OS <br /> R RINSED �Y N) METHOD RINSE AMOUNT <br /> iii ,. . JPs�crl� rsl._ <br /> N RINSATE DISPOSAL SITE �J�7 <br /> E MANIFEST # —OR— OTHER .. .. .. . <br /> V VAPORS PURGED_ ) METHOD AMOUNT USED <br /> q -. <br /> P L.-E. L. READING AT REMOVAL. (MUST'.RE l 20%) .— <br /> T R COMMENTS r y, <br /> _F_ <br /> N TANK MATERIA (STEEL ' FIBERGLASS, OTHER) TANK SIZE <br /> K C t <br /> O TANK CONDITION (GOOD POOR ' HOLE <br /> N <br /> • S PIPE MATERIAL (STEEL, <br /> FIBERGLASS, OTHER) # FEET' f <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> DEPTH SOIL- TYPE OBSERVATION , <br /> TSAMPLE # <br /> I N Aj�) rsrr� /G'r2 Q <br /> E K <br /> i� <br /> L <br /> • <br /> D <br /> EXCAVATION: SIZE: SEfix <br /> S X ,, YDS OF SOIL: J �S <br /> I A DEPTH SOIL TYP .E OASERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N - <br /> T G _ TRENCH DIMENSION v X X <br /> I -YDS OF_.SQIL <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> OD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: ;e SAMGLE'RS NAME <br /> CLOSUREIN PLACE MIXTURE: VOLUME: <br /> F <br /> ' <br /> .fi43 (10/89) <br /> t 23�.. <br /> 0 <br /> �� DRAW SITE MAP ON REVERSE <br />