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L <br /> PHS-EHD - UNDERGROU. TANK CLOSURE/ABANDONMENT 4SPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK. ONLY) <br /> 5-3C) <br /> .� OWNER NAME ff OWNER PHONE If r <br /> E '- -) , CCTG� )C' `l - '/ V3 <br /> N CONTRACTOR - , CON. PHONE# <br /> E <br /> R i SJLHD 'ERM I T # EPA # �' F IRE PERMIT # <br /> 3 <br /> A r' <br /> INSPECTOR Z DATE TANK # 39 - <br /> R RINSED (Y METHOD Ila /«r Grs RINSE AMOUNT <br /> I 1"a "S'nall <br /> N R I NSATE DISPOSAL SITE �i�C /lsc� <br /> S <br /> E MANIFEST # J7I�!�) %%�f5 �',� -OR- OTHER <br /> V VAPORS PURGED ( /N) METHO C�y /� AMOUNT USED <br /> A <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 20%) ;G s � <br /> q <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER) TFiNK. SIZE uL <br /> K C 7 Ao/oo/') cci) <br /> / 0 TANS: CONDITION ( OD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ((TE .; FIBERGLASS, OTHER) It FEET <br /> I PIPING CONDITION (GOOD, '00 R, HOLES) <br /> N xxK/Wis 442,00200 <br /> G DEPTH SOIL_ TYPE OBSERVATION SAMPLE It <br /> T <br /> F A =raw r <<r�� / w <br /> I N <br /> E K <br /> L <br /> r <br /> D EXCAVATION SIZE: X X .-_/1YDS OF SOIL : ���✓c/ <br /> S <br /> I A DEPTH SOIL_ TYPE OBSERVATION SAMPLE: <br /> N M P <br /> S <br /> F. T s <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X _ YDS OF SOIL_ <br /> 0 H DEPTH TO G. W. : F= SAMF'L T NG MEI E IOD <br /> ..........___._.___._. <br /> N c <br /> # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY-. 's l aA> S f�� SAMPLERS NAME : /007 (Gvewhi <br /> LL___ L CLOSURE IN PLACE MIXTURE : VOLUME : <br /> EH 23043 ( 10/89)x/89) DRAW SITE MAT-' ON REVERSE <br />