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PHS—EHD — UNDERGr ' ND TANK CLOSURE/ABANDONMF�INSPECTION <br /> (SHADED AREA T FILLED IN FOR THE FIRST , NK ONLY) <br /> E OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R / SJLHD PERMIT # EPA # h <br /> A . FIRE PERMIT # <br /> L <br /> INSPECTOR C ouw�- DATE y/4Z TANK # 39 <br /> R RINSED (Y N) METHOD <br /> I ArSsore RINSE AMOUNT©Ud.� ?34 9 <br /> N RINSATE DISPOSAL SITE VV <br /> S <br /> E MANIFEST # <br /> —OR— OTHER <br /> V VAPORS PURGED 6>N) METHOD <br /> A � AMOUNT USED t a /6., <br /> P L.£. L. READING AT REMOVAL (MUST BE ( 20% <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE .20 <br /> K C JP <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) 11 # FEE'( <br /> P T / <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> I N -e <br /> E K ileo c ewr 2 <br /> L <br /> D EXCAVA T N SIZE: � X ' O X / <br /> S YDS OF SOIL: �fSyols <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P 21 SAMPLE # <br /> S P I -Saute No SGc A^ 0� <br /> P L P o Coo - Z <br /> E I E o <br /> o -3 <br /> C N 6' s.a ..terriy, f. �a�ar •s onr aU . <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> O H DEPTH TO G. W. : <br /> N 2 FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O 1 OTHER SAMPLE: <br /> LABORATORY: �PSF Gdbt �S (�� SAMPLERS NAME: <br /> Al.rC2 •pP�+(tn! <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME; <br /> EH 22043 (10/89) DRAW SITE MAP (3N REVERSE <br />