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PHS-EHD - UNDERGROUr ' TANK CLOSURE/ABANDONMENT ISP'ECTION <br /> (SHADED AREA TO rILLED IN FOR THE FIRST T ONLY) <br /> "% ? Y �! UX?lY7'!7�YIR�SG� YL�Ih" v " f0tllYf!�ltYtDi/lXX� XX°OLWY✓yl�4�14in�/X <br /> ayh//v�lu i �wH(ifwruodviawiuruiuruwwwwwrawruwwww w�uL�'�ay�raiurriuwiauvuiliigiuiuiu�X� fff0191uuif-40:11 Wl' <br /> l � ruuruwfl <br /> OC. r-1 <br /> Y/ %rac Cum^ <br /> � OWNER NAME U � OWNER PHONE <br /> N CONTRACTOR �f O CON. PHONE# / <br /> R SjLHD <br /> PERMIT # EPA # 6?b FIRE PERMIT # X37= qo <br /> L ' flrLG v l�V"A i i r < i H e r� �vrG rG/ it- u r /. <br /> INSPECTOR I-Ice <br /> DATE TANK # 39 <br /> R I RINSED (ON) METHOD RINSE AMOUNT <br /> Z <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E I MANIFEST # -OR- OTHER <br /> V I VAPORS PURGED ON) METHOD ��, Co RMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N I TANK MATERIAL STEE FIBERGLASS, OTHER) TANK SIZE `v <br /> / I 0 I TANK CONDITIONGOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEE , FIBERGLASS OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G I DEPTH SOIL TYPE OBSERVATION I SAMPLE # s,� <br /> F A rO n," c <br /> se ' -e{i+N <br /> _ j i ) <br /> I N ` <br /> E K <br /> L <br /> D EXCRVATION SIZE: X 35 X / zr YDS OF SOIL: <br /> S <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 SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: (,✓ps� OvIs SAMPLERS NAMEnc g a� frn2l <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 ( 10/89) DRAW SITE- MAP ON REVERSE <br />