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PHS-EHD - UNDERGO UND TANK CLOSURE/ABANDONML-KT INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />!yl/Y(/IJ.�i%iiJii/iJ7/rYl/�L'LXUrIGMON//N//X/in/Avvoyrrrwu,.a <br />OWNER <br />/ ■ <br />PERMIT # <br />E PERMIT <br />•�///r.r'/1�I/i�■/%%0i/7/0 //.%/_//%///////!9/6///�/%/�//%�/ed./e%/i. /i. i. •. .l <br />.,,vn..,.,.....,_. ..�....,...,. <br />------ .,1 ru-i� c `-TEFTPOR(X(r� L��t��iif`�fwww/U// <br />INSPECTOR �/ � `0- /1 DATE TANK # 39 - �s <br />R RINSED (Y/N> METHOD <br />I RINS AMOUNT <br />N RINSATE DISPOSAL SITE <br />S <br />E MgNIFEST # -OR- OTHER <br />V 11 VAPORS PURGED (Y/N) METHOD1. <br />A AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 4 �S Lt�,Lr <br />T R COMMENTS <br />A <br />N TANK MATERIASTEE , FIBERGLASS <br />K C , OTHER) TANK SIZE <br />/ 0 TANK CONDITION (GOOD, 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 YPE OBSERVATION <br />T SAMPLE # <br />F A <br />I N . <br />E K <br />L <br />D EXCAVATION SIZE: X N - <br />S -.- X YDS OF SDIL: <br />I A DEPTH SDIL 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. : <br />N FT SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />V ULUPIE <br />EH 22043 (10/89) DRAW SITE MAP ON REVERSE <br />In <br />