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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> Jill ull <br /> E OWNER NAME-Ta1� WkHZ;_ I Ty', OWNER PHONE # �o ��L _ 6� � <br /> N CONTRACTOR �owngr CON. PHONE# <br /> E <br /> R SJLHD PERMIT # N EPA # y` y� FIRE PERMIT # u <br /> A <br /> L <br /> INSPECTOR­�a n DATE;J�qlqj TANK # 39 - <br /> R RINSED N) METHOD r //7 r cRINSE AMOUNT/oor�� <br /> I <br /> N RINSATE DISPOSAL SITE G <br /> E MANIFEST # J Z -OR- OTHER <br /> V VAPORS PURGED Y 'N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STEE , FIBERGLASS, OTHER) TANK SIZE JL OC10 <br /> K C <br /> / 0 TANK COND I T I O OORv GOOD, PHOLES) UO h l'f t?' P U ICS + �ur1'C9'i'k ' w� <br /> N <br /> S PIPE MATERIAL (STFIBERGLASS, OTHER) I # FEET Z0 <br /> P T - <br /> I PIPING CONDITION (GOOD, 0 R, HOLES <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION Sbl SAMPLE # <br /> T Da ��! t�rct � 17ofe - ( GGu or - DO- <br /> F A �i Ov- Y O- <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 3 X ZZ X YDS 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 <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> 0 <br /> N 0 # OF HOURS SINCE DEWATERING: W -r In <br /> 0 OTHER SAMPLE:�t1C1 'r �? ^(�'�q.�'r� 6YY1 �-1¢t37t� _ /2��O �C'�r�f?' <br /> LABORATORY: C 7 L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: 7A <br /> VOLUME: <br /> 23043 (10/89) DRAW SITE MAP ON REVERSE <br />