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PHS–EHD – UNDE102OUND TANK CLOSURE/ABANDO*NT INSP-ECT17N <br /> (SHADED AREA <br /> yTO BE FILLED <br /> %ylIN FOR THE F7II�JiYyRS7pu�Ta rTANK ONLY) <br /> IlF) #4u"i <br /> SE VF_ 160 S W% OSTM7 "-rcp,-,- <br /> r <br /> OWNER NAME 2 V C OWNER PHO E (# <br /> E Zo �_ z 3 9—x'181 <br /> E , , CONTRACTOR I 'L ( � /' vi3T CON. PHONE# 2Z <br /> R , SJLHD PERMIT # l EF' � �'r��r' �% �� FIRE PERMITI#�.qN�� <br /> A <br /> L � / <br /> INSPEC T DATE 12zi <br /> (� TANK # 39 <br /> I RINSED Y N) METRO CE 2iSF RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # _ –OR– OTHER <br /> V VAPORS PURGED l//N) METHOD T_ AMOUNT USED <br /> A J C;� <br /> P L. E. L. READING AT REMOVAL (MUST PE ( 20'/•) <br /> 0 <br /> T R COMMENTS <br /> A S <br /> K C TANK MATERIAL STEEL, FIBERGLASS, OTHER) TANK SIZE p 00 0 <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T _ � r <br /> E K CCO <br /> L <br /> DS EXCAVATION SIZE: > X J2 X C7 YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <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 X YDS OF SOIL <br /> I — -- <br /> 0 H DEPTH TO G. w. FT SAMPLING METHOD <br /> N 2 ---- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY- <br /> SAMPLERS NAME:C Re <br /> CLOSURE IN PLACE MIXTURE: VOLUME - <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />