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PHS—EHD — UNDERND TANK CLOSURE/ABANDONM* INSPECTION <br />*,— <br />(SHADED AREA —0 <br />T FILLED IN FOR THE FIRST TANK ONLY) <br />IBE <br />Al IN c.�ii.�ir�Ev� <br />- �ita�i/'�/�t'ti.�a' iitli�}fiyir'l,/��J'�.Ydi <br />'r�rr� �.v <br />� . <br />lk <br />E <br />OWNER- NAME <br />�-f P4 <br />OWNER PHONE # <br />N <br />E <br />CONTRACTOR Sr-:Oo- <br />.:t L _D <br />PHONE# _z_ <br />[ CON. cf "? — ?—' 1 <br />RSJLHD <br />A-, <br />PERMIT # EPA # <br />-6 <br />FIRE PERMIT # <br />L <br />INSPECTOR ,64, -- <br />DATE -T /'70 TANK # :39 0 Z__ <br />• <br />R <br />I <br />RINSED (Y/N) METHOD RINSE AMOUNT' , <br />N <br />RINSATE DISPOSAL SITE <br />Ad"I'l <br />S <br />8-e'e-- '52'2"eLe- )P-10' &K <br />31 <br />E <br />MANIFEST # —OR— OTHER <br />A <br />VAPORS PURGED (56? tD <br />TAP, AMOUNT tb/food <br />P <br />-- <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 <br />T <br />R <br />COMMENTS <br />A <br />N <br />K <br />c <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES t <br />N <br />P <br />S <br />T <br />PIPE MATERIAL (§T rEt, FIBERGLASS, OTHER <br />I <br />N <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />T <br />DEPTH SOIL TYPE— 041SERVATION SAMPLE <br />- tv-4,ke W, k 0,010 r 1 sa <br />F <br />A <br />1 ats;e&I'V44, <br />I 6941t C - <br />o7 <br />titN w <br />E <br />K <br />L <br />0 <br />S <br />EXCAVATION SIZE: X Z X 1( YDS OF SOIL: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />N <br />M <br />P <br />SAMPLE <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />I <br />G <br />TRENCH DIMENSION X X YDS OF SOIL <br />0 <br />N <br />H <br />a <br />DEPTH TO G.W.:FT S AMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />EH 213043 (10/89) DRAW SITE MAP ON REVERSE <br />