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;. PHS--EHD _ UNDERfGRO '] TANK CLOSURE/ABANDONMEN'. i NSPECT I ON <br /> y 6 <br /> (SHADED AREA jJO BE FILLED IN .F©R' THE FIRST TANK ONLY) <br /> . 1 <br /> w!Tfrjff fff <br /> f FR <br /> �/4/m, <br /> F '4 5s F fly; <br /> lceW i 3 <br /> OWNER NAME . r <br /> E u t LI t -5 OWNER PHONE # �6 <br /> N , CONTRACTOR Q ¢_ l� CCIN. PHONE# 20 <br /> R SJLHD PERMIT # y A U FIRE PERMIT # f . <br /> L <br /> INSPECTO DATE f 0 , TANK # 391112-29-- <br /> R <br /> O� - �- <br /> --- <br /> R RINSED (Y/ ) METHODS RINSE AMOUNT V <br /> I /1! <br /> N RINSATE DISPOSAL SITE <br /> S j II <br /> E ;MANIFEST # € -0R- OTHER <br /> AV :VAPORS PURGED Y/N) , METHOD <br /> ,J�y :Ce� . AMOUNT USED U . <br /> P L.E. L. READING I AT REMOVAL <br /> (MUST+ BE ( 2G•�G) <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL {STEEL FIBERGLASS,; OTHER) TANK SIZE �,(� <br /> K C <br /> / O TANK COND X T I ON (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ((STE'EU FIBERGLASS,. OTHER) =FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N s ;. <br /> G Ei DEPTH SOIL TYPE OBSERVATY.DN <br /> pSAMPLE # <br /> T 77 p - ' <br /> F A 'r I d <br /> I N <br /> E K <br /> L <br /> D EXCAVATION ;PSIZE:' <br /> S X X ..�Z YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATLON <br /> N M P SAMPLE # <br /> t <br /> S P I i, <br /> P L P <br /> E I E ' <br /> C N <br /> T G TRENCH :DIMENSION X = X' YDS OF SOIL <br /> Ir. --- . <br /> O H DEPTH TO G. W. : ��� FT ' SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE: DEWATERING: <br /> O OTHER SAMPLE: , <br /> LABORATORY.: SAMPLERS NAME: <br /> CLOSURE IN PLACE fMIXTURE: <br /> VOLUME: <br /> H 23043 (10/89) G, W SITE MAP' ON' REVERSE _ <br />