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i <br /> PHS--EHD -- UNDF� ) -.)UND TANK CLOSURE/ABAND8%d ^ `1T INSPECTION ' <br /> (SHADED AREA-1 U BE FILLED IN FOR THE FIRST TANK ONLY) <br /> Till <br /> �UakG � E1�i� / aF. FrFFKontT STf1cr,L�7"�hJ <br /> E OWNER. NAME OWNER PHONE # <br /> CONTRACTOR � CON. PHONE# <br /> G A SJLHD PERMIT # EPA # FIRE PERMIT # ?> 0 <br /> L <br /> INSPECTOR -r DATE 1/3�/a f TANK # 39 ' - <br /> R <br /> ,9 --R RINSED METHOD .r�l�� RIuS R I NSE AMOUNT <br /> I <br /> S RINSATE DISPOSAL SITE 4NWOWAV rl4vlA0�Z%i6 *L_- <br /> E MANIFEST # -OR- OTHER <br /> AVAPORS PURGEDN) METHOD ppb __LAMOUNT USED 16 ' <br /> p L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 = 6 ©2. : <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (" E , FIBERGLASS, OTHER) TANK SIZE <br /> K C f 000 <br /> O TANK CONDITIONC)pD 'OOR, HOLES) <br /> N <br /> S PIPE MATERIAL- STEE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I <br /> N PIPING CONDITION (GOOD, POD HOLES) <br /> G DEPT SOIL TYPE OBSERVATION <br /> - T SAMPLE # <br /> F A cat F ¢ <br /> I N Off` i a <br /> E K + <br /> L <br /> D EXCAVATION 5IZE: rX LAX p <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> F' L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> -- <br /> 0 H DEPTH TO G. W. : <br /> N. SAMPLING FT METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP pN REVERSE. <br />