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PHS-EHD - UNDEOOUND TANK CLOSURE/ABANDONMNT INSPECTION <br /> u(SHADED <br /> r2AREA <br /> x/uTO BE <br /> OBE FIuLrLEDGiIN FOR THE FIRST TANK ONLY) <br /> y u Ev�f/ S�P'Trel <br /> F V� 40097,16 <br /> E OWNER NAME .�z C OWNER PHO E <br /> N CONTRACTOR-�r P G� ( ) T CON. PHONE# <br /> E <br /> R SJ HD PERMIT # EPA # FIRE G RMIT # <br /> INSPECTOR% ` DATE j z /bap TANK # 39 - ✓r ---------- <br /> R <br /> �--- <br /> R RINSED (Y/N) METHOD [RINSE L R//vS� RINSE AMOUNT oa <br /> I <br /> N RINSATE DISPOSAL SITE r' SG!✓ <br /> S <br /> E MANIFEST # -OR- OTHER <br /> RVAPORS PURGED YN) METHOD R AMOUNT USED (� <br /> G L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL/ (STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITIO (G001O, POOR, HOLES) <br /> N <br /> S F'IF'E MATERIAL <STEELj' FIBERGLASS, OTHER) # FEE"f <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH T SOIL TYPE OBSERVATION SAMPLE # <br /> F A e eou� d o <br /> I N sA 14 Ae <br /> E K <br /> L <br /> D S EXCAVATION SIZE: ? X > X YDS OF SOIL: 80 ` <br /> l <br /> I A DEPTH SOIL TYPE OBSERVATION SA ALE # s <br /> N M P <br /> S P I — <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X �7i)( YDS Of- SOIL_ 3 <br /> I <br /> 0 H DEPTH TO G. W. : F"f SAMPLING METHOD <br /> N - --- - <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: CANON I57 SAMPLERS NAME: s � , <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />