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PMS—EHDUNDEFsle UND TANK CLOSURE/ABANDON .T INSPECTION <br /> (SHADED AREA su SE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER- NAME OWNER PHONE # <br /> .s <br /> N CONTRACTOR CGN. F'HDNE# <br /> E C-[� , <br /> R SJLHD PERMIT # EPA # <br /> A - <br /> R <br /> . FIRE PERMIT # <br /> L �, <br /> INSPECTOR'CI s DATE TANK # 39 - © <br /> R RINSED V N) METHO RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST# -OR- OTHER <br /> -7 <br /> METHOD <br /> V VAPORS PURGED Y N) <br /> q 1 CV_ AMOUNT USED 3 010 <br /> P L.-E. L.. READING AT REMOVAL (MUST BE < EG;t) <br /> 0 E C) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE. R.162C 3D-L- <br /> K C ( <br /> 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N `'e- C <br /> i" S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR JIOLES) `` i <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION j <br /> T !at- S SAMPLE # � <br /> F r I <br /> ry <br /> I N . <br /> E K tv A2 <br /> L <br /> D EXCAVATION SIZE: X X a c ! <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P I <br /> P L p <br /> E I E <br /> C N <br /> T G N X �.� X YDS F SOIL <br /> I TRENCH DIMENSION i <br /> a H DEPTH TO G. W, : FT SAMPLING METHOD F <br /> N ? <br /> G # OF HOURS SINCE DEWATERING: <br /> i <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURC: <br /> VOLUME; <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />