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PHS-EHD - UNDERUND TANK CLOSURE/ABANDONMI/ INSPECTION <br /> (SHADED AREA f,-,BE FILLED I N FOR THEf�{F II RSI',-4/fANNK ONLY) <br /> NIH III /wY/!/�/%/�i� /�f//////////1/YJ//�////// ��lJ / // mill,/ <br /> vl, 2l� i c� Fi LL �j �i Scv Lfs 111 1z�c <br /> OWNER NAME 7�-,74 OWNER PHONE # <br /> E l c�✓Ufa sai <br /> / N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHDPtRMIT # EPA # FIRE PERMIT # <br />/ A <br /> INSRECTOR � �✓ DATE <br /> -/Yly3 TANK # 39 <br /> IRINSED (Y�I METHOD ' RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED &N) METHOD d,1 ,« AMOUNT USED �So/ti�e�. <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, <br /> N <br /> r SRIPE MATERIAL <br /> P T STEEL, FIBERGLASS, OTHER) # FEET C S' <br /> I PIPING CONDITION (GOOD, POOR, HOLES) G S <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F <br /> AA0 <br /> I 'N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X _�� YDS OF SOIL: <br /> S <br /> I A DEPTHL TYPE OBSERV ION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> T G TRENCH DIS ION X X YDS OF SOIL 3� <br /> I <br /> -T <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD A zs 6 <br /> N <br /> 0 #. OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> r`A/ �� <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (14/89) DRAW SITE MAP ON REVERSE <br />