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PHS-EHD - UNDERGROO TANK CLOSURE/ABANDONMENT#ISPECTION <br /> (SHADED AREA TO FILLED IN FOR THE FIRST T ONLY) <br /> �raw�w�rH�i�rEvwruarruwwwruwwwruwarwruwiuruwww riaH� �Jraruwiuwruwiuvr uruiuiu �w<rr�iuwruwru r ruwiu <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E h <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> Lri u ' r a r e S 1 i H <br /> INSPECTOR C t/G DgTE TANK # 39 <br /> R I RINSED (9N) METHOD �7re� U/ G WpsJ� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E I MANIFEST # -OR- OTHER <br /> V ' VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) c o G <br /> 0 O <br /> T R COMMENTS <br /> A <br /> NTANK MATERIAL<(STEEL, FIBERGLASS, OTHER) TANK SIZErr`� �Ur� <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S I PIPE MATERIAL (STE L, FIBERGLASS OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION I SAMPLE # Gver� <br /> i T <br /> F A C nra a e; n s� is e <br /> I N c t v <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X 3s X YDS OF SOIL:Erv��� E'Xrcu. I/c ^ i2i y' <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 /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> lo--IE <br /> I OTHER SAMPLE: <br /> I <br /> LABORATORY: SAMPLERS NAME: <br /> l^✓Q it Lrr� 4Ji•5 c !zf <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />'; 2;043 ( 10/89) DRAW SITE MAP ON REVERSE <br />