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PHS-EHD - UND,�_3,_,, <n <br /> UND TANK CLOSURE/ABANDdTSML.,T INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) v <br /> All <br /> r ��o ,7�f' ��✓D �S� G� , <br /> E OWNER NAME �� bo ne-�� OWNER PHONE <br /> N CONTRACTOR <br /> E Sf CON. PHONE# <br /> c�(111, � <br /> R SJLHD PERMIT # � ,� 00232-.5 6� FIRE PERMI11 T <br /> A # <br /> ' <br /> L <br /> INSPEC 0 <br /> DATE _ D TANK # 39 - �.37 - �_-•-- <br /> R RINSED Y/ ) METHOD�I Le �S¢ RINSE NSE AMOUNT <br /> N RINSATE DISPOSAL SITE r) L <br /> S SU <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED YON) METHODA )A AMOUNT USL_D,2., <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL 7(s <br /> EEL FIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / O TANK CONDITION (GOOD, 'POOR, HOLES) <br /> N &- <br /> • S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) ,FEET /[�Ig' \j`l'Z �hV <br /> P T v <br /> I tfz- <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A '►'� 't , 2 CLti 7 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X ___.L X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAhIPLE # <br /> S F' I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> --- <br /> 0 H DEPTH TO G. W. : 9ry _ FT SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />