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PHS-EHD - UNDe,-/,ROUND TANK CLOSURE/ABAND['1r,_--,�'.ENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER. NAME <br /> d, <br /> OWNER PHONE # Ca <br /> N , CONTRACTOR CON. PHONE# <br /> E �- C�o cfS'— <br /> R t SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A . <br /> L <br /> - r <br /> INSPECTOR DATE rj as J`^Q TANK # 39 <br /> R RINSEDMETHO. FRINSE AMOUNT <br /> f <br /> Ic,crvvl�� <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHOD � � AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE 201%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STEED, FIBERGLASS, OTHER) TANK SIZE <br /> K C �( <br /> / 0 TANK CONDITION (GOOD P00 HOLES) mss, r <br /> N f G,�'ti I1.0 J-JS(p�� <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> 6 PE <br /> F q <br /> I N 7� + <br /> E K nc <br /> L <br /> D EXCAVATION SIZE: _ L X X SrSYDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S PI <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 SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUMC: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />