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PHS–EHD – UNDIERI&UND TANK CLOSURE/ABANDONAT INSPECTION <br />(SHADED v AREA TO BE t1 FILLED IN FOR THE FIRST TANK ONLY) 0 <br />OWNER-NAME <br />E OkD OWNER PHONE # <br />N CONTRACTOR 5zf3oz-D <br />E CON. PHONE# <br />AR SJLHD PERMIT # EPA CACctoy,,;643 FIRE PERMIT # <br />. <br />L tv <br />INSPECTOR —(Agz41F_mk DATE 1�/cl lqo TANK # 39 – <br />R RINSED Q�VN) METHOD--f-r'A -RINSE AMOUNT <br />N RINSATE DISPOSAL SITE <br />S`7 1 <br />7 10' <br />E MANIFEST # –OR– OTHER <br />V VAPORS PURGED 3D <br />AAMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE <br />0 20%) 7 <br />T R COMMENTS q= - <br />A <br />N C TANK MATERIAL FIBERGLASS, OTHER) <br />K SIZE <br />0 TANK CONDITION (GOOD, POOR, HOLES frA <br />N K�� - - <br />S I PIPE MATERIAL�E FIBERGLASS, OTHER) # FEET <br />PT ---------- <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE ®BS �EJVATIQN, <br />SAMPLE <br />T <br />F A - <br />IN COO <br />E K C '5®,( <br />c9 6m <br />L C -OZ <br />DS EXCAVATION SIZE: I'L x X ib YDS OF SOIL: <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 X <br />I X YDS OF SOIL <br />0 H DEPTH TO G. W.: FT SAMPLING METHOD <br />N a - --- <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />