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PHS-EHD - UNDERGRq l:T, p TANK CLOSURE/ABANDONMEN(,' '.INSPECTION <br /> (SHADED AREA ToQ FILLED I N FOR THE FIRST IK ONLY) <br /> r �vvr �v//iwrdra� r dAL-V,—o 'V .�Gri-��rci T"Icfv.1 <br /> OWNER NAME , OWNER 'PHONE '# <br /> �'G�e v.gra G! S ire c s <br /> N CONTRACTOR CON. F-H NE# /O _ �Y <br /> E Cu/c��'�. L�.'E'r� �i�r <br /> R SJLHD,-PERMIT # EPA FIRE PERMIT # � <br /> L IMF <br /> INSPECTOR DATE i��G/g3 TANK # 29 - 113--5- <br /> R <br /> 13.;R RINSED 1:5/N) METHOD 74rr�J/e RINSE AMOUNT 7.30 <br /> N RINSATE DISPOSAL:,SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED 67,N) METHOD ia r AMOUNT USED �'`� <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) f <br />� rR] <br /> TCOMMENTS <br /> i A <br /> N TANK MATERIAL STEE FIBERGLASS, OTHER) TANK SIZE SObO <br /> K C <br /> / ❑ TANK CONDITION: (GOOD, (00R) HOLES) <br /> N _ <br /> S PIPE MATERIAL ((STEE FIBERGLASS, OTHER) # FEET / 70 <br /> IP T <br /> . ILPIPING CONDITION (GOOD, POO HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T r <br /> F A � L� 5�� ' w 7 H a Sa`!/ rLea <br /> s/ <br /> E K i <br /> L -I </ S? <br /> D EXCAVATION SIZE: G1D/X �� �X /�/' YDS OF SOIL: a5- <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATIONSAMPLE # <br /> N M P <br /> S P I <br /> ;P L P <br /> i E I E <br /> C N ` <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> E <br /> 0 H DEPTH TO G.'W, : FT SAMPLING METHOD <br /> i N 2 IJIruSS v <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME::—7 <br /> /11�dr <br /> CLOSURE IN PLACE MIXTURE: VOLUME: + <br /> Eh X04., (10/89) DRAW' SITE MAP ON REVERSE <br />