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PHS—EHD — UNDERC,--JUND TANK CLOSURE/ABANDONML-6T INSPECTION
<br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY)
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<br />. . r "Hu. I LMF'QRA"R"Y•,•CC
<br />lul INSPECTOR 4i `OL A DATE
<br />R RINSED Y N) METHOD
<br />I ,
<br />/(Q� RINS A O
<br />N RINSATE DISPOSAL SITE
<br />S
<br />E MANIFEST #
<br />—OR— OTHER
<br />V VAPORS PURGED N) METHOD
<br />A ( (�- AMOUNT USED
<br />F' L.E.L. READING AT REMOVAL (MUST BE ( 20%) Gi� CSL
<br />0
<br />T R COMMENTS
<br />A
<br />N TANK MATERIAL TEE FIBERGLASS, OTHER) TANK SIZE
<br />K c I�ODD
<br />/ 0 TANK CONDITION (GOOD, DOR HOLES)
<br />N Nao6V; s
<br />S PIPE MATERIAL E, FIBERGLASS, OTHER) # FEET
<br />T
<br />I PIPING CONDITION (GOOD, OR HOLES) u
<br />N f I :!
<br />G DEPTH SOIL TYPE OBSE V j ON
<br />T SAMPLE
<br />F #
<br />A
<br />I N _(
<br />E K 8
<br />L b(
<br />D EXCAVATION SIZE:2A X YD,, _D X c �
<br />S � OF .,DIL:
<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 X
<br />I X YDS OF SOIL
<br />0 H DEPTH TO G.W.: FT
<br />N SAMPLING METHOD
<br />U # OF HOURS SINCE DEWATERING:
<br />0 OTHER SAMPLE:
<br />LABORATORY: w(1%i(f SAMPLERS NAME: flr&e&lUU
<br />CLOSURE IN PLRCE MIXTURE:
<br />VOLUME:
<br />EH 2,3043 (10/89) DRAW SITE MAP ON REVERSE S;it S 4fj". l,/
<br />
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