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PHS-EHD - UNDE` IOUND TANK CLOSURE/ABANDOo _NT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER NAME,�,X �D11�1/LXCC0. OWNER PHONE <br /> E CONTRACTOR CON. FHDNE# (Zcx=� � <br /> R / SJLHD PERMIT # EPA #ja o683$ FIRE PERMIT # 1 � <br /> A r r r r <br /> L <br /> INSPECTORDATE TANK # 39 - (41 _ - � r <br /> R RINSED (Y ) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE LCo ( s�l w�L� l {O{✓L o� <br /> S ^ <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (DN) METHOD �Q AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) LEL.j/o �L=-7' <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (. E FIBERGLASS, OTHER) TANK <br /> K C SIZE Z <br /> / 0 TANK CONDITION (GOOD, GOO Vu� <br /> N <br /> S PIPE MATERIAL (STEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A s" GA d a.� BSc .uN SSS <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE : X X � <br /> S YDS OF SDIL : <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 <br /> N SAMPLING METHOD <br /> 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> II LABORATORY: R� SAMPLERS NAME : <br /> �S Li �h <br /> CLOSURE IN PLACE MIXTURE: VOLUME : <br /> -!' 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />