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PHS-EHD - UNDER 'JND TANK CLOSURE/ABANDON1 i INSPECTION <br /> (SHADED AREA I-L' BE FILLED IN FOR THE FIRS Y TANK ONLY) <br /> OWNER NAME CIA <br /> OWNER PHONE # ' <br /> N `; CONTRACTORF� Jemmy CON. PHONE# / <br /> E �C,-�� � o <br /> R SJLHD PERMIT # <br /> A . � CEPA # 9&" FIRE PERMIT # c <br /> L <br /> INSPF_CTORU� I DATE ��/ . TANK # 39 - _ <br /> i <br /> R RINSED (Y/ ) METHOD <br /> I fj^��?rt �'�,�� RINSE AMOUNT .a <br /> vp <br /> N R I NSATE DISPOSAL S ITE r✓ �`PSvfrnG Lvc-(s <br /> L E_ MANIFEST # <br /> -OR- 0 ER- <br /> V VAPORS PURGED (Y N) METHOD <br /> A Ut I -I AMOUNT USED •���5 <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS <br /> K C , OTHER) TANK SIZE t/ <br /> TANK CONDITION (GOOD POOR, HOLES) /L� <br /> N <br /> j S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> P T # FEET $fie <br /> iv� c2•• �c <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A 1' : <br /> I N .� r <br /> E <br /> K � <br /> L _ <br /> D :EXCAVATION SIZEe <br /> S ...� X X ,j 5' YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: <br /> LcrGs SAMPLERS NAME- <br /> CLOSURE <br /> AME:CLOSURE IN PLACE MIXTURE: <br /> VOLUME <br /> EH 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />