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PHS—EHD — UNDERGRC D TANK CLOSURE/ABANDONMEN ,}NSPECTION <br /> (SHADED AREA TO �t FILLED IN FOR THE FIRST TANK ONLY) <br /> FWgjlfA ar [owrA� �i r� a r a w a r r Yl W. <br /> �tiryr�. Cie ('3o E �' , <br /> rE OWNER NAME � 6U4kl�' OWNER PHONE # 3�S Z0 <br /> N CONTRACTOR CON. PHONE# <br /> E C'hrs r�nS cit <br /> R SJLHD PERMIT # EPA x, 5 ,Sy j FIRE PERMIT # <br /> A <br /> L it <br /> INSPECTOR �� DRTETANK # 39 <br /> R RINSED (Y ) METHOD RINSE AMOUNT _ n <br /> I t55cc^�t GJ:.S "/s a�C <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # 7o58; 9% —OR— OTHER <br /> V VAPORS PURGED (Y ) METHOD h AMOUNT USED O� S <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE C 20X) 3 o/O ' 2Ppj <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEEL, FIBERGLASS, OTHER) TANK SIZE �n <br /> K C <br /> / 0 TANK CONDITIONOO POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T s <br /> F A Clc. c, nr <br /> E K <br /> D EXCAVATION SIZE: IY X $ X 7 YDS OF SOIL: / 0 cAS <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 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O❑ OTHER SAMPLE: <br /> LABORATORY: Fc-,L_ I SAMPLERS NAME: / I. r= <br /> CLOSURE IN PLACE MIXTURE: VOLUME: IC <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />