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PHS–EHD – UNT� �' ROUND TANK CLOSURE/ABAND� ENT INSPECTION <br /> 'f (SHADED AR6 TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> soffaffem <br /> !�'F'tUl�t7r STf�LrLTI�I�I - <br /> E OWNERNAME OWNER PHONE # <br /> JA <br /> . <br /> F N CONTRACTOR �L-/�. ��rx-Tr CON. PHONE# , 1 <br /> 1 E <br /> a <br /> R SJLHD PERMIT # EPA # FIRE PERMIT <br /> INSPECTOR �.-� DATE 0 6/c�/ TANK # 39 – 110 T4 _� <br /> IIS ff <br /> R RINSED ((ON) : _ METHOD l&-57 0-I11Sc RINSE' AMOUNT <br /> - I - <br /> N RINSATE DISPOSAL SITE <br /> S � 64mq �-Iv w 11�p�1�/�Mh9� <br /> E MANIFEST # =OR� OTHER <br /> V VAPORS PURGED N) METHOD AMOUNT USED <br /> A � � o fb <br /> P L. E. L. READING AT REMOVALr� <br /> (MUST RE < �G%).�.� <br /> O <br /> T R COMMENTS <br /> A <br /> N <br /> K C TANK MATERIAL tj� FIBERGLASS, OTHER7 TANK SIZE jpl r <br /> / O TANK CONDITION (GOOD,(:F HOLES) <br /> N <br /> x.. S PIPE MATERIAL Q:F� FIBERGLASS, OTHER) # FEE"f <br /> P T <br /> I PIPING CONDITION (GOOD, DR OLES) <br /> N - - <br /> f G DEPTH SOIL TYPE 1 OBSERVATION SAMPLE # <br /> T <br /> F A w t •a <br /> t I N <br /> 'Soil &lscpfA62Lt' <br /> E K <br /> L <br /> El <br /> D EXCAVATION SIZE: J—, X IDl�y YD5 OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE ' OBSERVATION SAMPLE # <br /> N M P <br /> S p I <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION - X X YDS OF SOIL <br /> I E <br /> O H 'DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: I' <br /> LABORATORY: SAMPLERS .NAME: <br /> CLOSURE IN PLACE MIXTURE: VILUh1E: <br /> EH 23043 ( 10/89) DRAW SITE 'MAP ON REVERSE <br />