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PHS-EBD - UNDERGROC D TANK CLOSURE/ABANDONMEN''fNSPECT ION D I <br /> i (SHADED AREA TCFILLED IN FOR THE F I RSTAK ONLY) <br /> OWNER NLJ�M 1» OWNER PHONE .# <br /> E - Moc .2 0 9 r 8:357-70 ^7/ <br /> N CONTRACTO en <br /> E f 1� k �- CON. PHONE# Z.G Cr_ 93,/ _6 S/ 0 <br /> R .F 5JLHD PERMIT # <br /> AEPA`i���s� 9�/ FIRE PERMIT #BGO <br /> . /i . <br /> J <br /> I NSPEC ❑ DATE J TANK. # <br /> R RINSED Y N) METHOD j- <br /> /,c r.•�S2- - R I NSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> ,E MANIFEST # _OR- OTHER <br /> V VAPORS PURGED Y/ ) METHOD <br /> q �,e AMOUNT USED - <br /> P L.-E. L. READ I NG AT REMOVAL (MUST B ( 20X) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEL , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> ❑ TANK CONDITION (GOOD, POOR HOLES) i <br /> N <br /> S PIPE MATERIAL TEEL FIBERGLASS, OTHER) FEE"C 1 f } <br /> P T [ <br /> I PIPING CONDITION (GOOD, POOR, -.HOLES) fes. I <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION � <br /> T SAMPLE #i <br />{ F A �Lt14A2 421 H. i <br /> I N T <br /> IE K <br /> L <br /> D EXCAVATION SIZE: X S OF SCI <br /> S X YD "SOIL: <br /> : <br /> I A DEPTH SOIL TYPE OBSERVATION <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 <br /> I X X YDS OF. SOIL <br /> O H DEPTH TO G. W. : <br /> N .1 FT SAMPLING ME'CHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: S�GL1p�j4 ¢� k SAMPLCRS NAME <br /> u15 -TA AVS <br /> CLOSURE IN PLACE MIXTURE: ^�-- <br /> VOLUNC: <br /> (10/89 ,11 JJ DRAW SITE MAP ON .'REVERSE <br />