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_ 1 <br /> PHS-EHD - UNDERGf,-,. D TANK CLOSURE/ABANDONMEi l: INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE F II RST"'LANK ONLY) <br /> ,y�/ <br /> � �� r �uao cv .►o iuivaaav�co .cv�ureoavav�w .vi �ii �i'" <br /> NMI= <br /> = 7a"� ��+�� <br /> p r-g r,�e-10 � N• Mq� G.J PC <br /> OWNER NAME J OWNER PHONE # _ 3- 76 / <br /> E O� C <br /> ECONTRACTOR (7-is �Q� �aN CON. PHONE# dam_ 3. _060 _ <br /> R SJLHD PERMIT # EPA #C'AG600 FIRE PERMIT # -3 A10,4 ck <br /> A <br /> L i <br /> INSPECTOR DATE 3p%q� TANK # 39 - 3 7 - oL <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> SUAr2. WQS(� <br /> I <br /> N RINSATE DISPOSAL SITE Scr�1/ces <br /> S <br /> E MANIFEST # ,9og2'736529if2� -OR- OTHER <br /> V VAPORS PURGED tY N) METHOD AMOUNT USED OD/ <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST- BL < COX.) <br /> 0 <br /> T R COMMENTS -30Ip P� L EL. <br /> A �\ <br /> N TANK. MATERIAL (STEEL, FIBERGLASS_-ASS;- OTHER)" TANK SIZE LV <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES), O O S <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITIO (GOOD POOR, HOLES) <br /> N -- — --- -- -—- -- SAMPLE"# <br /> G 'DEPTH SOIL TYPE OBSERVATION <br /> T /Vev d oT No /SCa a G� �+ 4 I os� 'J <br /> I N <br /> E jE D CAVATION SIZE: _LL. X 13r X ..jj YDS OF SOIL: 96 <br /> S SAMPLE # <br /> I APTH SOIL TYPE OBSERVATION <br /> N M S P P LE I <br /> C N YDS OF SOIL <br /> T G TRENCH DIMENSION X X <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> O -# OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: 0 - .S'15 <br /> LABORATORY: Luh SAMPLERS NAME:mlo /3ul is <br /> CLOSURE IN PLACE MI TURE: VOLUME: <br /> ON REVERSE <br /> �W ;^:0043 ( lcN/B9) DRAW SITE- MAP <br />