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PHS-EHD - UNDERGRb,- ,D TANK CLOSURE/ABANDONMERT-� INSRECTIQN <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> luli�/ ,��,y�,��/�% <br /> I�u/fr /uf��uuauJi�>uiu !ululuururiuuruisaivai>u / ui>rIRE "7ir3ulu!/r//r/ru//r>L�iu r�ruroJu ""7ri,76 <br /> QWNER NAME �� j�a C��i°�(� /�7��F' <br /> '�`�� OWNER PHONE # <br /> E ( � � � y 7 <br /> E CONTRACTOR , �� CON. F�HONE#CIAO <br /> R /SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> Lr rrr � rrr rr r ,G <br /> �7 <br /> INSPECTOR DATE g � TANK # <br /> R RINSED (YA) METHOD-77., p RINSE AMOUNT f <br /> N RINSATE DISPOSAL SITE -j' <br /> S <br /> E MANIFEST # -0R- OTHER <br /> V VAPORS PURGED (Y N) METHOD , AMOUNT USED <br /> A i <br /> P L. E. L. READING AT REMOVAL (MUST RE` < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATER I AL ,� Tt�`�L,) FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK, CONDITION (GOOD, POOR, HOLES) <br /> N � <br /> S PIPE MATERIAL ESTE LELE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F � <br /> A <br /> I N � » � <br /> E K <br /> L <br /> D EXCAVATION SIZE: Ly X X YDS OF SOIL: <br /> S [ it <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> P L P ' <br /> E I E <br /> J <br /> C N - - <br /> T G T RENCH D I MENS-tON 2 f�X � X r YDS OF SO I L <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING: <br /> L OTHER SAMPLE: <br /> a <br /> LABORATORY: j("u ce y C SAMPLERS NAME- M6rp' V- .z <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 233o'4?, ( 10/89) DRAW SITE MAP ON REVERSE <br />