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UNDERG t t <br /> PHS-EHD �D TANK CLOSURE/ABANDDNMt�;�f INSPECTION <br /> (SHADED AREA TO FILLED ` <br /> FILL(/ED IN FOR THE F,yI�RST I"NK ON <br /> �� ODDZ�f 7d 9 7 � 5, �.^- �n � Y�-� G��>b• r <br /> E OWNER NAMErM ��1� r OWNER PHDNE # ` �,./ �� v <br /> N CONTRACTOR W� '` r. ,J�. <br /> EM CON. PHONE# / D 3 7T �Sg/ <br /> R SJLHD PERMIT # EP d °y`� 7 -f7 FIRE[ PERMIT # T <br /> A qd -6as` <br /> INSPECT DATE j�WTANK # .39 <br /> R RINSED (Y N) METHODJH�Leef AS RINSE AMOUt�.L;� <br /> I �TT�t rfAz <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGEDY N) AMOUNT USED <br /> A METHOD <br /> �.� 1c-e _. I <br /> P L.E.L. READING AT REMOVAL (MUST BE < 2o%) <br /> O <br /> T R COMMENTS <br /> A . <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) <br /> K C TANK SIZE <br /> / 0 TANK CONDITION (2LOD2 POOR, HOLES) <br /> N <br /> —[— <br /> x S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, <br /> N BOOR, HOLES) '- <br /> /!��/i✓ !�2/G/L �)CGafV7� I <br /> T G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A y 5 C� -„i r G'JG �-z1IIAI { <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE; X 12 <br /> 2 X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAM E # <br /> N M P I <br /> S P I r t/A- <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION XX YDS OF SOIL <br /> I . <br /> O H <br /> DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 ---j <br /> . be, <br /> 0 # OF HOURS SINCE DEWATERING: /-'�; hes <br /> O OTHER SAMPLE: One G4/Gr-1e-r- SGS /e 7,4-, A&,_ <br /> rof �+J,�-7�d►'r <br /> ,,w fie,, elZ <br /> LABORATORY; SAMPLERS N <br /> GQ c� FA;Z2772� G LG'fr/ES <br /> CLOSURE IN PLACE MIXTURE: VOLUME: ' <br /> ZH 23043 (10/69) DRAW SITE MAP ON REVERSE { <br />