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PHS-EHD - UNDERGRD TANK CLOSURE/ABANDONMENINK <br />NSPECTION <br />(SHADED AREA TOVE FILLED IN FOR THE FIRST ONLY) <br />i h lelf , MIA <br />c to t % .2`f �J• E1w, Lcr <br />j <br />OWNER NAME OWNER PHONE # <br />N CONTRACTOR CON. RHONE# <br />,Ivfir- PT Tv <br />R SJLHD PERMIT # EPA # FIRE PERMIT #[�,^ <br />A <br />L 1. <br />NSPECTOR �DATE TANK # 39 - f:R66 <br />RINSED (Yo METHOD ,4 RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />MANIFEST # 17016 -OR- OTHER Crye <s'7'i <br />VAPORS PURGED (Y/ ) METHOD t), AMOUNT USED I�1b <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />COMMENTS <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE bpoy <br />TANK CONDITION GOOD POOR, HOLES) <br />,/u !mac 45 <br />F'IF'E MATERIAL ( STEEL, FIBERGLASS, OTHER) # FEET <br />PIPING CONDITION ( GOOD, POOR, HOLES) <br />7-1DEPTH I SOIL TYPE I OBSERVATION SAMPLE # <br />T <br />A <br />N <br />K <br />P <br />I <br />P <br />E <br />EXCAVATION SIZE: 16' X S X •-, <br />DEPTH I SOIL TYPE I OBSERVATION <br />TRENCH DIMENSION X <br />0 H DEPTH TO G. W.: FT <br />N 2 <br />0 # OF HOURS SINCE DEWATERING: <br />[EO][:ETHER SAMPLE.: <br />YDS OF SOIL: j ;?o <br />SAMPLE # <br />MOBILE <br />CHEM LABS INC. <br />Joseph Lo Vole <br />Senior Environmental Chemist <br />5021 Blum Road, Suite 3 <br />Martinez, CA 94553 <br />Phone (415) 372-3700 <br />Fax (415) 372-6955 <br />LABORATORY: CA -4? P7 ZC46 -7N c SAMPLERS NAME:- �rti <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />