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PHS—EHD — UNDER`]UND TANK CLOSURE/ABANDONT INSPECTION <br />(SHADED AREA IU BE FILLED IN FOR THE FIRST TANK ONLY <br />a r ai <br />V!C-f0^ lo' <br />OWNER-NAME , <br />E OWNER PHONE # <br />' 109 y <br />- r/Cil, <br />N CONTRACTOR L� <br />E KP IT� TG I i c1 CON. PHONE# _ <br />R SJLHD PERMIT # iAc onn J <br />y <br />A. ,�„ EFA # n36 FIRE PERMIT4, fi 3i;'1 <br />L} <br />INSPECTOR C <br />U� DATE TANK # — 633 yichr — _J____ <br />R RINSED (Y N) METHOD <br />I T, k RINSE AMOUNT <br />N RINSATE DISPOSAL SITE <br />i <br />S <br />E MANIFEST <br />—OR— OTHER /1 70 r <br />V VAPORS PURGED (Y N) METHOD <br />A b Zr�:, AMOUNT USED O% <br />P L.E.L. READING AT REMOVAL (MUST BE <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE �O <br />K C <br />/ O TANK CONDITION (GOOD, POOR, HOLES) <br />N AP5 <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G � <br />DEPTH SOIL TYPE OBSERVATION . <br />T l l7 -,p _ -1-/< I�. t�/ SAMPLE # <br />i <br />I N No <br />E K �s "ail1N <br />L <br />D EXCAVATION SIZE: <br />S X X YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION i <br />N M P SAMPLE # <br />S P I <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X X <br />I YDS OF SOIL <br />O H DEPTH TO G. W. : <br />N ----. FT SAMPLING METHOD <br />G # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />=cod—s3a - o36i �� <br />.._ <br />LABORATORY: �� <br />��`SAMPLERS NAME; <br />lccq <br />CLOSURE IN PLACE MIXTURE: 4Nde% �Pa% <br />,OLUPIE <br />EH 03043 (10/89)11 <br />D AW SITE MAP ON REV.€R t__ <br />