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PHS--EHD -- UNDERGRJ�%1ND TANK CL.OSURE%ABANDONME�j INSPECTION. <br /> (SHADED AREA .TUE PILLED IN FOR. THE FIRST TANK ONLY) <br /> ' OWN'ER- NAME (f ly G OWNER F'HDNE # <br /> y <br /> N CONTRACTOR CON. F'HONE#ti / <br /> E "I L h,f/L (SDN S% <br /> AR SJLHD PERMIT -# . " Z-7/ ba13 1 FIRE PERMIT, 7 ' <br /> L r <br /> INSP C R DATE TANK # / 6 <br /> 39 — 5 <br /> R RINSED (Y/ ! METWOi) Q � O u 6 RINSE AMOUNT <br /> I - J <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E ' MANIFEST # —OR— <br /> OTHER <br /> V + VAPORS PURGED1tV) � - <br /> A1. METHOD � � AMOUNT USED/ s/ <br /> F' .. L. E. L. READING AT REMOVAL (MUST BE ( 20% <br /> 0 <br /> T R ! COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLAS , OTHER) TANK SIZE <br /> K C <br /> 1 0 TANK CONDITION GOOD, POOR, HOLES Ofi✓� / �/� <br /> N I-) <br /> S '.PTFE MATERIAL (STEEL, IBERGLAS , OTHER) # FEET <br /> P T <br /> I PIPING CONDITIDN tGOC7P <br /> N OOR, HOLES) . '�� '+ <br /> _ <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE 4 <br /> AA <br /> I N - © d <br /> E K <br /> L <br /> D EXCAVATION SIZE:. 3 X X /� YDS OF SOIL: -7Z- <br /> I A DEPTH SOIL TYPE- OBSERVATION <br /> N M P SAMPLE # <br /> S F' I <br /> P L P 7i { <br /> E I E <br /> C N f <br /> T G TRENCH DIMENSION X aX YDS OF SOIL 3 <br /> O H DEPTH TO G. W. : F-TSAMPLING J�IETHOD <br /> N 2 �- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> Oy OTHER SAMPLE: <br /> LABORATORY: � �� - <br /> SAMPLERS NAME. — <br /> ES' � ' IcdlMiSf :( <br /> CLOSURE IN PLACE MIXTURE: e,C ly�d <br /> VOLUME: <br /> EH 23443 ( 14/D9) <br /> . DRAW SITE MAR ON REVERSE <br />