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PHS-EHD - UNDEROUND TANK CLOSURE/ABANDONM� INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER NAME ( F Zi 0ti <br /> OWNER PHONE # <br /> e <br /> E , , CONTRACTOR � � �N S CON, PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # G <br /> A <br /> J <br /> INSPECTOR I�p� DATE .j(Z2� IGS TANK # 39 <br /> R RINSED (Y N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S �2�C(CSU� <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD� <br /> A ( Ic-Q AMOUNT USED � � <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 20% <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL .(STEEL,, FIBERGLASS, OTHER) TANK SIZE <br /> K C L <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N Cor'io5l <br /> S PIPE MATERIAL \ (STEE , FIBERGLASS, OTHER) # FEET / <br /> G T <br /> I PIPING CONDITION (GOOD„�GOOR, HOLES) <br /> ” <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A I - +- 5iL-r O . .'Z- <br /> �)c 2. <br /> I N o �r <br /> E K <br /> L <br /> DEXCAVATION SIZE: � i <br /> S <br /> -+ X X �� YDS OF SOIL: J <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M G SAMPLE # ' <br /> S P I <br /> F' 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. : 1GYu FT <br /> N SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: {JIB VOLUME:. <br /> EH 030143 ( 10/89) DRAW SITE MAP ON REVERSE <br />