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RHS-EHD - UNDERGO-.D TANK CLOSURE/ABANDONML,,wf- INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> A- <br /> OWNER- NAME OWNER PHONE # C <br /> E 2_U J_ 3 <br /> N CONTRACTOR 7 <br />. E CON. PHONE# <br /> R ,� 5JLHD PERMIT # pq 6.5 <br /> A , FIRE PERMIT # Y 404 <br /> L ' <br /> INSPECTRA DATE <br /> �-�� --`�G TANK # 39 <br /> R RINSED (Yf ) Z��::]�METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S Cc: Tr/C-s / <br /> E MANIFEST # --OR- OTHER <br /> V VAPORS PURGED Y ) METHOD �. AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST E ( CU7t) <br /> 0 <br /> T R COMMENTS � <br /> A / <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE 14)d6? <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HDL <br /> N D <br /> S PIPE MATERIAL (STEC , _FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F q <br /> E K <br /> L <br /> D EXCAVATION SIZE: / <br /> S X X ., YDS OF SO I L: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I i 0111 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H LDEPTH TO G. W. : FT SAMPL I NG METHOD <br /> N 2 <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �L SAMPLERS NAME: <br /> MA,)?A,)? K F'edclC <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />:H 22043 (10/89) DRAW SITE MAP ON REVERSE <br />