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PHS-EHD - UNDERGRO TANK CLOSURE/ABANDONMEN NSPECTION r/ �r <br /> (SHADED AREA Tr-IW FILLED IN FOR THE FIRST`HNK ONLY) <br /> pvl <br /> EOWNER- NAME <br /> Pj S OWNER PHONE # <br /> N CONTRACTORJL CON. PHONE# <br /> R SJLHD FERMI _ # d ' <br /> a AFIRE PERMIT ## <br />�i L <br /> INSPEC 0 DATE TANK # <br /> R RINSED (Y/N) METHOD A/ <br /> I /v RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> h v VAPORS PURGED (Y N). METHOD AMOUNT USED <br /> G L.E.L. READING AT REMOVAL (MUST BE/ <br /> a � U <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) Sd 4n,� k <br /> N V <br /> S PIPE MATERIAL t TEEL, IBERGLASS, OTHER} # FEET <br /> P T .3 <br /> I PIPING CONDITION (GOOD, -BOOR, HOLES} <br /> N 1 <br /> G DEPTH SOIL TYPE OBSERVATION 5 <br /> T SAMPLE # h <br /> F <br /> I N GvAl <br /> L K <br /> D EXCAVATION SIZE: �� X ' <br /> S -- X YDS S OF SOIL: <br /> A DEPTH SDIL TYRE OBSERVATION C/ <br /> N M P SAMPL :it <br /> S P I s <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. . <br /> W. <br /> N ---yZ FT 7 <br /> SAMPL-I NG METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> o OTHER SAMPLE: <br /> LABORATORY:, SAMPLERS NAME <br /> ____J_ <br /> CLOSURE IN PLACE MIXTURE: VOLUME: f"A4-7r� REI) <br /> co <br />.H 2-30043 { 10/89} DRAW SITE MAP ON REVERSE <br />