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PHS—EBD '' <br /> UND ROUND TANK CLOSURE/ABANDONT INSPECTION <br /> (SHADED AREA 1-0 BE FILLED IN FOR THE� FIRST TANK ONLY) <br /> � r rwiw�viwurrw�iw �v <br /> � � rww� wiwiu.viw �yrly urir w is <br /> Soy A-7c.cc 0- wrw uw <br /> E OWNER NAME �t ah g <br /> � OWNER PHONE ## 'I <br /> N CONTRACTOR �I <br /> ES�/n(c7 CON. PHONE# iE <br /> R SJLH PERMIT # <br /> jf <br /> { A EPA # C,4c a,,crj OYa IIFIRE PERMIT # <br /> L / u"L"idtr�G�a/�- <br /> y " e^ <br /> � I <br /> { DATE <br /> INSPECTOR U� TANK r <br /> I 0"o;t,;; j# 39 — c9� -9 <br /> R RINSED (Y/N) METHOD <br /> I � oS / I; RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED N) METHOD <br /> A AMOUNT USED <br />' Gu-� li <br /> P L. E. L. READING AT REMOVAL (MUST BE ( Orax) <br /> 0 <br /> T R COMMENT <br /> A l <br /> N K (STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> 1 / O T 0 (GOOD, POOR, HOLES) '} <br /> N <br /> r: S PIPE ATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> I P T <br /> r 5' � <br /> I 'IPING ONDITION (GOOD, DOR, HOLES) <br /> N <br /> G EPTH SOIL TYPE OBSERVAT SAMPLE # <br /> T i <br /> F q <br /> I N E <br /> E K q <br /> L <br /> D EXCAV ON SIZE: X X YDS OF IL: <br /> �fvcl� <br /> SO <br /> S t <br /> I A DEPTH SOIL TYPE OBSERVATION r SAt`°LE # <br /> N M P !# M <br /> S P <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION 417 X <br /> i X v� tYDS .OF SOIL 3 <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: k <br /> Ik t7 OTHER SAMPLE <br /> LABORATORY: G SAMPLERS NAME;II /I <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME. <br /> 'H ~0 " ( 3o/89) DRAW SITE MAP ON REVERSE <br /> e <br />