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PHS-EHD - UNDERGROND TANK CLOSURE/ABANDONME* INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ',' �./�/.�'rr�,/�//f./ /�/ r'.•�7.��/,G��'�/'!%r.�, 'r�r'r�/�/i.�' �/ , . �y�,�j�/�.r,�4%r> . r�/�/ i,/;; , /i,�/'!J <br /> lU.l1!/.(r/%JU llllf!///111�1,; 1 <br /> or 1Y <br /> OWNER NAME cr. OWNER PHONE # j <br /> E . <br /> N CONTRACTOR F: CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # 73 <br /> A <br /> j INSPECTOR DATE �}.� (�-TTTANK # 39 D <br /> I R RINSED (Y4 METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD J-)h.c i C-c- AMOUNT USEDIr,�) <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) �,gA 6) 1-en <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR,) HOLES) <br /> N <br /> S P'IP'E MATERIAL STEEL,,,-�" FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, . POO HOLES) lSfe ¢ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T � <br /> F A ,, - o <br /> I N <br /> E K C # tc <br /> L c c SGL <br /> D EXCAVATIONIZE: X X _e2- YDS OF SOIL: / 7 <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I /2 , <br /> P L I P <br /> iE I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> p # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> �BORATORY-jUy- iQ/ SAMPLERS NAME: f <br /> CLOSURE IN F'LACE MIXTU � VOLUME: I <br /> EH 2-304-3 ( 17/89) DRAW SITE MAP ON REVERSE <br />