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PHS-EHD - UNDE; LROUND TANK CLOSURE/ABANDO' ANT INSPECTION <br /> (SHADED AREAW BE FILLED IN FOR THE FIWT TANK ONLY) <br /> E OWNER NAME 7urilCo s cic OWNER F'HONE # Z <br /> E , , CONTRACTOR w CON. PHONE# ZG _��� -61.2 <br /> i <br /> R SJLHD PERMIT # <br /> A EPA #rAc-�-Lsc. l{ FIRE PERMIT # C C1> <br /> ` <br /> J <br /> INSPECTORDATE / TANK # 39 - 2-e12-9' <br /> 2 <br /> R RINSED (Y N) METHOD / ,- , <,c r RINSE AMOUNT T <br /> I > <br /> N RINSATE DISPOSAL SITE <br /> S ^t 7i uR r P d'CPs / oma/ <br /> E" MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (9N) METHOD <br /> A RMOUNT USED , <br /> T _ Ulti� <br /> G L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> Ivq- <br /> T R COMMENTS_ <br /> A <br /> N TANK mATERL 11 lrSTEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C d <br /> / O TANK CONDITION (GOO , POOR, HOLES) <br /> N <br /> P T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET N A- <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G <br /> T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: �_ X S X <br /> S c �'n YDS OF SOIL: �� <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L G <br /> E I E <br /> C N <br /> IG TRENCH DIMENSION X X YDS Uf= 50IL <br /> -- — <br /> 0 H DEPTH TO G. W. - FT SAMPLING METHOD <br /> N 2 -- <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ro�oti')x' SAMPLERS NAME: <br /> 'tGIN'.� 1 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />