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PHS-EBD - Uh1DE% ND JTANK CLOSURE/ABANDON? , INSPECTION <br /> (SHADED AREA ,dE FILLED IN FOR THE FIRSANK ONLY) <br /> +'o F=k�C1p�d <br /> OWNER NAME , <br /> E S(,c.,�� OWNER PHONE # <br /> E CONTRACTOR i <br /> 4-(,64 CON. PHONE# <br /> RSJLHD P RMIT # EPA # <br /> A- FIRE PERMIT # <br /> L1 11 <br /> INSPECTOR' <br /> KDATES 7�� <br /> . 1U TANK # 39 <br /> R RINSED (Y4N) METHOD T1� i <br /> I P (24 n R I NSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A I CQ AMOUNT USED L7 <br /> P L. E. L. READING AT REMOVAL (MUST BE < �GX) <br /> zc <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL FIBERGLASS, OTHER) TANK SIZE <br /> K c <br /> O TANK CONDITION (GOOD, POR, HOLES) <br /> N <br /> S PIPE MATERIAL S EE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, OOR HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A - r ii <br /> I NROL <br /> E K ci - <br /> L <br /> I <br /> D EXCAVATION SIZE: 3Z X ZX '� <br /> S � YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I -0-- , <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO S. W. : rpAicoiramcFT <br /> N 2 SAMPLING METHOD <br /> G OF HOURS SINCE DEWATERING: — <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> CT,li l 11.1 flC SAMPLERS NAME: <br /> ck)-kc _ <br /> CLOSURE IN PLACE MIXTURE: VOLUME: ii'' <br /> mmmmmmmmmm� L �_ -11_1�1 2� ) I 1�- <br />=H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />