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PHS–EHD – UNDERI. )UND TANK CLOSURE/ABANLJNF,JT INSPECTION <br /> f (S(HHADDEEjD� AREA luBSE FILLED <br /> INf�FOR THE <br /> ay�FIRST <br /> py�yTANK ONLY) <br /> �/ yE���f�IC.i' iY:fv�li�'l�V1t'k✓'�v���i.�iilv����b�":fY (1Q�%�' ' tvlv��wl1/yiil!%�u��� '�'y.�!H�/i'yy���'!v'7Llir / <br /> OWNER NAME. <br /> E // DARE CONS��J OWNER F'HONE # [ _ Zc(Li6 <br /> N CONTRACTOR <br /> E �gLCv�I�vNGOcv6Gc. CEN. PHONE# �7C�_37ZZ <br /> R SJLHD PERMIT # EPA # cAC aroS35000 <br /> A i / FIRE PERMIT # /7 1F <br /> L <br /> L J <br /> INSPECTOR Fkl6DATE TANK # 39 <br /> _ C <br /> R RINSED (Y/N) METHOD- RIND <br /> I RINSE RMUUNT l�0 <br /> N RINSATE DISPOSAL SITE 1p )- <br /> S '1 �+N�/iP.-4 ✓i 35 fA- 3�l �aly Ga�53 Z,,E MANIFEST # _ b1,56 <br /> -OR- OTHER _ <br /> V VAPORS PURGED (Y%N) METHOD L <br /> R E AMOUNT USED [(p l{s <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2UF> <br /> 0 <br /> T R COMMENTS <br /> A K%c <br /> N TANK MA"fERIAL (STEEL FIBERGLASS, OTHER) TRNK SIZE <br /> K C IZtiLr�GA Lvl s <br /> / O TANK CONDITION (jGOO POOR, HOLES) <br /> N <br /> S <br /> T (STEE PIPE MATERIA s FIBERGLASS, OTHER) # FEET 0 2--72--7P <br /> I PIPING CONDITION (GOOD, POOR, HOLES) A(L <br /> N <br /> G DEPTH SOIL TYPE OBSER ATION <br /> T r SAMPLE # <br /> F q 5�, <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: (Z' X ��' X <br /> S �.. YDS OF SOIL: I Lit> <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I / <br /> F L P ,sed a v u✓ ff 15 <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X c� C /' <br /> I -L_ X �[� YDS OF SOIL <br /> 0 H DEPTH TO G. W, : <br /> N 2 — FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUhIE <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />