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PHS--EHD - UNDER.*6 TANK CLOSURE/ABANDONME INSPECTION <br /> (SHADED AREA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br /> M %CYC!Y�/i rS /i3C�rY�rXG:// . r/�Y�/v✓L%��l� /. '�i�'��/ �y?.'r f r�fi i'a kr a vc�r�rnvrlrrvii ver >� �iv rul r r � "Jirs rXr �5171/j/ZYr'/ <br /> xlrrr� eiii drr uslr�iriwsrr <br /> p� E OWNER NAME��I�� c� C-�V , 6,,--p OWNER RHONE # � �fJ I q`1-,h 7- <br /> N CONTRACTOR Jim D ho' CON. PHONE# <br /> I E U +�f <br /> I R SJLHD PERMIT # �,J IA EPR #CAO-001' FIRE # <br /> PERMIT <br /> A fv2fZ - �'J cC�tt7 <br /> r <br /> INSPECTORO' f <br /> (,trvv� l � .�`r_ DATE 1 TANK. # 39 - z - <br /> RINSED ) METHOD -FTf � N fsAMOUNT <br /> RINSATE DISPOSAL SITEDewn 1t <br /> E� MANIFEST # 7, —OR— OTHER -4� C� ` 3--f3 <br /> V VAPORS PURGED (YYN) METHODs,e.2. AMOUNT USED � �f},� r®��J <br /> A <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 20%} <br /> a (..�9� G2 �)Q LC� <br /> i r L <br /> T R COMMENTS �,� � fh � v <br /> A p�� <br /> 0` <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE �{ 1 <br /> K C &6 ff �l <br /> / 0 TANK CONDITION (GOOD, BOOR <br /> N - HOLES) <br /> S PIPE MATERIAL (STEEL, 'FIBERGLASS, OTHER) # FEET � 13 <br /> P T <br /> I WIPING CONDITION (GOOD, . POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE ORSERVATTON SAMPLE # <br /> T r- a- r ovvti—1oa a<k [4 <br /> 1 N t r 1 l l E 1 "`--.7 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X r'/X � YDS OF SOIL: <br /> S ' <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P t1,0 T Q-t ti L <br /> E I E <br /> C N - <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. ���--W FT SAMPLING METHOD <br /> N 2 1 1[j <br /> -�`s-� # OF HOURS SINCE DEWATERING: �+` /� 6vo 1375 �Aki1 <br /> 0 � OTHER SAMPLE: <br /> LABORATORY: /� t7,� SAMPLERS NAME <br /> �I <br /> CLOSURE IN PLACE MIXTURE: IK VOLUME: <br /> '. I 23043 (lo/B9) DRAW SITE MAP ON REVERSE <br />