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PHS-EHD - UNDti.;J,ROUND TANK CLOSURE/ABANDdti ENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 17 <br /> M-4-5 <br /> ey OWNER NAME S / - m I OWNER PHONE # <br /> E f`'°'� Cab9 9�s— l spa <br /> E • CONTRACTOR l CON. PHONE# Caoq Q <br /> L i <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A . <br /> L <br /> INSPECTOR DATE TANK # 39 - oZ 6 _ 001- <br /> R <br /> 01-R RINSED (Y/N) METHOD RINSE MOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED CN) METHOD AMOUNT USED '1_t,a._ <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BEU( 20%) <br /> O <br /> T R COMMENTS <br /> A So 0 <br /> N TANK MATERIA (STE , F I BERGLASS, OTHER) TANK S I ZE6 �,5" ,� <br /> K C <br /> / O TANK CONDITION (GOOD, OOR 'HOLES� �G <br /> N L <br /> 1' S <br /> P T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE' <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A , <br /> I N 0 c E� <br /> E K s <r <br /> L <br /> D S EXCAVATION SIZE: X X � YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I EaC N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> -7 LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (14/89) DRAW SITE MAP ON REVERSE <br />