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PHS-EHD - UNDERGR JD TANK CLOSURE/ABANDONMEI, INSPECTION <br /> (SHADED AREA TO `3E FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAMEr1 "� `nx <br /> E D �j%'J7DY� ER HONE <br /> E CONTRACT OR U/L F U/ ' T� CON. PHONE# T T <br /> „�Yl <br /> R % SJLHD PERMIT # / <br /> A . ' ', EPA # FIRE PERMIT <br /> INS EC 0 <br /> DTANK # 39 <br /> AT —TT <br /> R RINSED ( N) METHOD RINSE AMOUNT <br /> I ��// L4AMOUNT D <br /> N RINSATE DISPOSAL SITE F (;,, eotIre SeftVlc2S , <br /> S 0 <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y IV) METHODAhIUUNT USED <br /> A K� c� o L1�s <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20X) / o <br /> 0 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS <br /> K C OTHER) TANK SIZE <br /> / O TANK CONDITION GOO , POOR, HOLES) <br /> N -� <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T �y <br /> I PIPING CONDITION r GOOD,) POOR, HOLES) e/Z cxdjac � <br /> N <br /> u k <br /> G T DEPTH SOIL TYPE OBSERVATION <br /> SAMPLE <br /> F # _ <br /> A <br /> I N GLS_ T T <br /> E K <br /> D EXCAVATION SIZE: � � � <br /> S X '-1_ X Z YDS OF SOIL: 2 �s <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X _ _ YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: ') SAMPLERS NAME: <br /> OL <br /> CLOSURE IN GLACE MIXTURE: <br /> VOLUhIE <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />