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o� <br /> PHS--EHD -- 'UNDERGRO_ ;D TANK CLOSURE/ABANDONMENT ' <br /> rIL <br /> 'INSPECTION .�- <br /> (SHADED AAREA! TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME ` y �� <br /> E �Od f ; P ; OWNER PHONE # <br /> N • . CONTRACTOR , L <br /> E 7J f?L� CDN. PHONE# <br /> R 1 SJLHD PERMIT # E D <br /> A FIRE PERMIT # ;k <br /> L <br /> I NSR'ECTO DATE 5 TANK # 39 _ <br /> I " R I N$ED (Y/ ) pi METHOD l / �e Ajjg�,14 1-- RINSE AMOUNT P� <br /> N RINSATE DISPOSAL SITE 3U <br /> S f/ <br /> E. MANIFEST # F Vj <br /> -DR— OTHER <br /> F <br /> V VAPORS PURGED 'I Y/ ) METHOD <br /> A �2 AMOUNT USED , <br /> P !;L. E. L. READ ING)IAT REMOVAL {MUST BE ( 20%) <br /> O .,' <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL LSTEEL FIBERGLASS, OTHER) TANK SIZE <br /> K c UC�U <br /> / D TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ISTEELFIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N P. <br /> G DEPTH SOIL .TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 1-7 X / <br /> SMF _ YDS OF SOIL: <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M (? SAMPLE * <br /> S P I p <br /> P L P <br /> E I E <br /> C N61 <br /> sE <br /> T G TRENCH DIMENSION <br /> I „ --- X X YDS OF SOIL <br /> D H• DEPTH TO G. W. ; FT SAMPLING METHOD <br /> N <br /> 0; # OF HOURS SINCE DEWATERING: <br /> O' OTHER SAMPLEF: <br /> LABORATORY: m <br /> GARS! 7SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> F VOLUME: <br /> 3043 (10/89) <br /> DF�++ SITE MAP ON REVERSE j <br /> � 1 <br />