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PHS-EHD4 - UNDERGRf`ND TANK CLOSURE/ABANDONMEt4F_`YNSPECTION <br /> (SHADED AREA TO FILLED IN FOR THE OWN <br /> -i,,..,AK ONLY) <br /> a �"TaiN aWIN�� <br /> flew-��ai Sid c/c/v l <br /> OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON. F'H NE# ;/y -,�y3 y <br /> R SJLHD�PERMIT # EPA #C:�CGcD�9ra,�r FIRE PERMIT # � <br /> A <br /> L _tL <br /> INSPECTOR C7 , Z DATE TANK # 39 - i/ 3S <br /> R RINSED 0N) METHOD �r " RINSE AMOUNTJip �-Ifu - <br /> I - <br /> N RINSATE DISPOSAL; SITE / <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (!Y A) METHOD AMOUNT USED <br /> A �v.•{� .L. y <br /> P L. E. L. READING AT REMOVAL (MUST BE ( LO%) t o <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTEFL FIBERGLASS, OTHER) TANK SIZE <br /> K C lOOU <br /> / O TANK CONDITION (GOOD, q9PHOLES) <br /> N <br /> % 5 PIPE MATERIAL EEL FIBERGLASS, OTHER) # FEET C <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) N �- <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A , T? � c.o7 W <br /> I -N / d'vc W <br /> L f6(R n ! Wce3-3— <br /> D <br /> D EXCAVATION "SIZE: Lar X _6_� X Sl r 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 f <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FTSAMPLING METHOD S S <br /> N 2 <br /> O # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: C j SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />