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PHS-EHD - <br /> UNDER 'JND TANK CLOSURE/ABANDONMINSPECTION <br /> (SHADED AREA T -.-AE FILLED IN- FOR THE FIRSTCYANK ONLY) <br /> is rrrr a"7��i.7v� Zr a � � � �la:�ri i v a7u iy r Wi ,v a a u r <br /> c/t <br /> Arl <br /> OWNER NAME OWNER PHONE # , <br /> N CONTRACTOR <br /> E �G�� fFc� �� � CON. PHONE# <br /> R SJLHD .PERMIT # EPA # F IRE PERMIT # <br /> A <br /> L --L- a <br /> 0 <br /> INSPECTOR <br /> (T, p-� DATE ��rY�9 TANK # O/ <br /> R RINSED (Yo METHOD RINSE AMOUNT <br /> � I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED &/N) METHOD - AMOUNT USED <br /> A v ick _-Z A s P_c:_. <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS �n SCS w %� o ..L„ //f L1 5 �- ^.7 <br /> A � wy � �Q�a/7 31,5 <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> N <br /> Y' S PIPE MATERIA TE L,) FIBERGLASS, OTHER) # FEET G s <br /> P T <br /> I PIPING CONDITION (GOOD, , HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A �� .swla�c��a;, AN <br /> I <br /> 'IV <br /> E K S �lc <br /> L <br /> D EXCAVATION SIZE: X X � ' YDS OF SOIL: <br /> S <br /> I A DEPTH S 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 3y y�3 <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: 5u`�s i� 5anruK c ScSAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/89) ` T,� DRAW SITE MAP ON REVERSE <br /> s <br />