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PHS-EHD - UNDERGACD TANK CLOSURE/ABANDONMEO INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �,r�arcw�H�rEuwiuurruwwwiawiuwwwwiuiawwwww r u������wra��ruwwiuwi�aiuwi prrEr 2211 <br /> r�uwruiuiuw ruuriuwu <br /> ll <br /> OWNER NAME5 C�� ( OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIR£ PERMIT # <br /> v/. I , g ri pow mm/ y FAA <br /> C' <br /> INSPECTOR DATE jO'�� TANK # 39 - I /�-3 <br /> i <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> O TANK CONDITION (GOOD, POOR, HOLES) CX +11 � <br /> S PIPE MATERIAL (STEEL� OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T a 3, r- o <br /> F A o�.S7 <br /> I N25 <br /> E K <br /> L <br /> D S LJ <br /> EXCAVATION SIZE: X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I z- G <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: ,�J �,s,�ti �- SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE MIXTURE•: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />