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p <br /> PHS-EHD - UNDL ... ZOUND TANK CLOSURE/ABANDOtv 'NT INSPECTION <br /> (SHADED AREA -TO BE FILLED IN FOR THE' FIRST TANK ONLY) <br /> eL' s"suff/m4l , <br /> 19 JE <br /> OWNER- NAM r OWNER PHONE <br /> E # <br /> L <br /> NCONTRACTOR 81 CON. PHONE# <br /> E boa <br /> - <br /> R SJLHD PERMIT # EPA # ! FIRE PERMIT # , <br /> A <br /> L <br /> INSPECTOR 1 DATE 60 �- TANK # 39 4 - -La <br /> a <br /> R RINSED (Y/N) METHOD # RIN E AM NT <br /> I i <br /> N RINSATE DISPOSAL SITE ` <br /> E MANIFEST # -OR- J� OTHER <br /> V VAPORS PURGED (Y N) METHOD- �� AMOUNT USED <br /> i A <br /> a, <br /> P L. E. L. READING AT REMOVAL (MUST BE < GX) <br /> } O t <br /> s T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C A <br /> k / 0 TANK CONDITION( (GOQ , POOR, HOLES) �avqe�,_ y �ff� _ �� //�' <br /> N ���[ U"'l Fig'vv a v <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> N PIPING CONDITION (GOOD, POOR, HOLES) <br /> I$ <br /> s G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A 9F 0 61 <br /> I N t <br /> E K <br /> i L <br /> ' D S EXCAVATION SIZE: X X E YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION 'f SAMPLE # <br /> N M P <br /> r S P I <br /> 11 P L P y <br /> 4 E I E <br /> C N <br /> ' I G TRENCH DIMENSION X X YDS OF SOIL <br /> { <br /> 0 H DEPTH TO G. W. : FT ' <br /> N .� �AMPLIIVG METHOD <br /> ,t <br /> ` G # OF HOURS SINCE DEWATERING: ' <br /> } J <br /> O OTHER SAMPLE: w <br /> LABORATORY: L SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE MIXTURE: ij VOLUME: <br /> # I <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />