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PHS-EHD - UNDERGt JND TANK CLOSURE/ABANDONME INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> : � rr�(�r(rr/w(c/! '21 �� L/�/�/�r%/' ' ,�a � <br /> � 51 ��IV HI' !!/!//!/!/H 7/!////!/////1/////!//!///////////!///l.1 I �Y ///// ///r'/%/!//!//////!!/.,x <br /> A"- <br /> E" <br /> OWNER NAMEG�yf� �osL c � OWNER PHONE #(2vg) 7z 3Z-,o <br /> E 1 r77 <br /> N CONTRACTOR CON. PHONE# (Z ���,/- cJ6A? <br /> E S�tL <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> Lt 1 F( 11 H C CI i <br /> L TANK # S9 - ' <br /> INSPECTOR �� DATE �� /� � � - l <br /> R RINSED O?N) METHOD" � ���� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> i S <br /> E MANIFEST # -OR- OTHER <br /> i <br /> V VAPORS PURGED 4'Y/N> TMETHOD 7 AMOUNT USED `' , <br /> A <br /> R L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R FCOMMENTS <br /> i A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK. SIZE <br /> K CAll ' <br /> / O TANK CONDITION (GOOD, F)OR� HOLES) <br /> N <br /> S F'IF'E MATERIAL _STEEL, FIBERGLASS, OTHER) # FEET <br /> P T _ <br /> I PIPING CONDITION (GOOD, COQ R, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F ..' <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X /�- X _ YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> al <br /> OTHER SAMPLE: <br /> LABORATORY: j /�, ,� SAMPLERS NAME : -JODAIWV <br /> CLOSURE IN PLACE -I MIXTURE: I VOLUME: <br /> --Jl <br /> -i E:;o437 ( lo/89) DRAW SITE MAP ON REVERSE I <br />