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PHS-EHD -- UNDEROUND TANK CLOSURE/ABANDONM03 1" INSPECTION <br /> (SHADE,yD�r AREA TO BE FILLED I,yN�/ FOR THE FIRST TANK ONLY) <br /> r rr rr ir.v r rr rrirYir rr� <br /> OWNEROWNER PHONE # � J <br /> N CONTRACTOR /I C._- I0 <br /> E fo CON. PHQNE# D ° - , `" '`, <br /> R SJLHD F'ERM I T # EPA # ''' <br /> A FIRE PERMIT # <br /> L <br /> INSPECTOR I n <br /> C DATE TANK # 39 <br /> R RINSEDN) <br /> I METHOD RINSE O NT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -DR- OTHER <br /> V VAPORS PURGED (YEN) METHOD <br /> A . AMOUNT USED ,5 <br /> 1 <br /> P L. E. L. READING AT REMOVAL (MUST S ' ( <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL(STEE 9, F=IBERGLASS, OTHER) TANE', SIZE <br /> K C 1DC)o Cf <br /> / 0 TANK CONDITION (GOOD 'DOR HOLES) <br /> N <br /> X S PIPE MATERIAL _ S� FIBERGLASS <br /> P T , OTHER) # FEET <br /> I PIPING CONDITION (GOOD( POOR HOLES) <br /> N <br /> G ON DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N <br /> r <br /> L K <br /> SQ <br /> EXCAVATION SIZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE <br /> N M P OBSERVATION SAMPLE # <br /> S P. I <br /> PL F � <br /> E I E c <br /> c <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. <br /> N S FT SAMPLING METHOD <br /> ( 0 # OF HOURS SINCE DEWATERING: <br /> 0 ` OTHER SAMPLE: <br /> LABORATORY: <br /> et> /%I d G SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> -H 23043 ( jo/g+)) DRAW SITE MAP ON REVERSE <br />