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PHS—EHD — UNDERGROI 'VD TANK CLOSURE/ABANDONMEIT INSPECTION <br /> (SHADED AREA TO FILLED IN FOR THE FIRST WK ONLY) <br /> �---�r,7'X�.",.",'4/i,�.�/�i,�i,�/i.�YiYl�i.�7.,�!i�.s� i,Si,Y/i�✓X� i�%iii.�i,4i,�Di.�il�i,`ai,�✓i,�, i�f�Xri, i,� iq/rX�/rYliYl�i,S"/,�/�/i�.c�0i,�lr�D, '!i!i� <br /> =1 I Hl�rwwp!/aww/a/aw/aw/awwwww/awwww/Ja afi�fu�r/y�lrawiaiuwwwwiaiaiawwi rawwi�/awiaiawwru/awruw <br /> r_G I F-0 <br /> _ <br /> f OWNER NAMEf � `1< Aye5eo� OWNER PHONE # (2�) 56 S' -65�R� <br /> E . <br /> I N CONTRACTOR;i,�PE OCL CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA #� zz95 FIRE PERMIT #Z_-5 ( ZyG' <br /> ffz <br /> L t U 11 H C WE I I' H tt <br /> INSPECTORy�N DATE 3 ��Z TANK 39 <br /> I i <br /> R RINSED 62N) METHOD �AIAZ '1 RINSE AMOUNT / <br /> I <br /> N RINSATE DISPOSAL SITE A/o GA.Z, C>ZL_ <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED eAN) METHOD/ � 2GF I AMGUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) G�G I O/a GnL <br /> 0 i T R COMMENTS <br /> A <br /> N I TANK MATERIAL Q5TEZL4::l FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> 0 I TANK CONDITION (GOOD 00 HOLES) <br /> N <br /> S PIPE MATERIAL(:P L, FIBERGLASS, OTHER) # FEET <br /> P I T <br /> ION CONDITION (GOOD POOR,, OLES) <br /> N <br /> G DEPTH I SOIL TYPE OBSERVATION SAMPLE # <br /> T1� - ( <br /> I N <br /> F A � <br /> V t I�CvGu r, wy3GLAf_ <br /> E K <br /> L <br /> D I EXCAVATION SIZE: X (r X YDS OF SOIL: R �� <br /> S —^ <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> I . P L P <br /> ! E I E <br /> C N iT i G TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> 0 I H DEPTH TO G. W. : FT I SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINC£ DEWATERING: <br /> OTHER SAMPLE: <br /> �1 LABORATORY: C�� /� y—tyG,��- SAMPLERS NAME: AA( <br /> CLOSURE IN PLACE MIXTURE: I VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />