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ih <br /> PHS—EHD — UNDER ``rUND TANK CLOSURE/ABANDONM INSPECTION <br /> (SHADED AREA BE FILLER IN FOR THE FIRST TANK ONLY) <br /> OWNER- NAM <br /> E ' GI G ,Y, OWNER PHONE <br /> aac a 33- A� 7 .; <br /> E y CONTRACTOR 1 CON. PHONE# <br /> AR ,., SJLHD PERMIT # EPA # <br /> FIRE PERMIT # -� <br /> L r r r r r . r r r�V. CAr r '� <br /> a " <br /> INSPECTOR `z'� DATE <br /> TANK # 22 - 075 - �- <br /> R RINSED Y ) METHOD <br /> I RINSE AMOU T QUO <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # --OR— OTHER <br /> V VAPORS PURGED tY N) METHOD <br /> A AMOUNT USED <br /> P L.-E.L. READING AT REMOVAL (MUST BE .( 20% <br /> ° 5 �l . 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBE'.RGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (16O01) OO HOLES)J <br /> N S � <br /> x' S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) #'FEET <br /> P T <br /> I PIPING CONDITION. (GOOD,_ BOOR HOLES) cute <br /> N ND 6 V't . <br /> G DEPTH SOIL' TYPE OBSERVATION <br /> T SAMPLE # <br /> F q <br /> I N <br /> . E K <br /> L <br /> D EXCAVATION IZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P � � sCr.'�� y <br /> gfvwo E I E , u n y 'A� In- <br /> C N 9 <br /> T G TRENCH DIMENSION X X <br /> I k YDS OF.-SOIL <br /> 0 H DEPTH TO G. W. <br /> N ------ FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE:, <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> i E2043 ( 10/89) DRAW SITE MAP ON REVERSE <br /> LJrzL+,4_-4 Sae -�Pc ,�, ✓ <br />