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PHS-EhD - UNDERGR.- 4D TANK CLOSURE/ABANDONME,\ INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> '4CONTRACTOR <br /> .ra-��i .i�ER NAME OWNER PHONE # C� -C1f/4_EN CON. PHONES# �1 _� / 2,E Rl PERMIT # EPq # P D FIRE RERMIT #�� � LiLrt �flu uS1u+•t 1 i H+ ii i t(HhY L. <br /> INSPECTOR'_�M$U\kj DATE q•�,'17-12 TANK # 39 - 17 5� <br /> R RINSEDY N) METHOaf r' f}n� RINSE AMOUNT )�D <br /> I C� <br /> N RINSATE DISPOSAL SITE �� Q <br /> S I <br /> E MANIFEST # 2 1 L -OR- <br /> OTHER <br /> f AV VAPORS PURGED YJN) METHOD AMOUNT USED ZI b S <br /> i Y <br /> i a L. E. L. READING AT REMOVAL (MUST BE < EOX) 'L �z) <br /> k T R COMMENTS �-A k'o u�y-.J� I <br />} C TANK MATERIAL STEED, FIBERGLASS, OTHER) TANK SIZE <br /> 7 ,_ r�r t <br /> O TANK CONDITION (GOOD, POOR,F HOLES) <br /> P S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> PIPING CONDITION (GOOD, POOR, HOLES) t�� W oYl q-Z-Z <br /> r/r 5 i <br /> G EP OIL ITY��E 'Qp SEoa?ATION SAMPLE # <br /> T �� <br /> N 7V <br /> K <br /> EXCAVATION SIZE: . = X XYDS OF SOIL: <br /> S <br /> A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> M P <br /> S R I So I d r 1 Yi o1 ; ` <br /> L P M , <br /> r I E <br /> N <br /> I G TRENCH DIMENSION X X YDS OF SOIL <br /> H DEPTH TO S. 'W. : FT1 SAMPLING METHOD �, ���� <br /> N 2 <br /> ' 1 0 # OF HOURS SINCE DEWATERING: �D <br /> I � <br /> O I OTHER SAMPLE: �L� <br /> LABORATORY: 1Y'' { SAMPLERS NAME• <br /> I CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVE=�S-= <br />