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4 { <br /> PHS-EHD - UNDE 7UND TANK CLOSURE/ABANDOPJT INSPECTION <br /> (SHADED AREA Zu BE FILLED IN FOR THEJ;FIRST TANKONLY) �LJ <br /> wvrX� wrvw a 'XO'l/ <br /> J ww !61/bliluwlu !!!!/!/y((/�//`/LI / / <br /> %41 S ff 1 1 1 {f L!lrl�//!lN <br /> E <br /> OWNER- NAME 7 r� r V <br /> 1 v h. Cir OWNER PHONE #` <br /> N CONTRACTOR " Zai- vc.c' r 3 Z <br /> E CON. PHONE# Zd 7/ <br /> R / SJLH PERMIT # and ' �Y�^G rrz y <br /> <, EPA # FIRE ' PERMIT <br /> r <br /> l� <br /> INSPECTOR °{ <br /> C v7� DATE �- TANK # Sg <br /> R � RINSED N) <br /> I METHOD j�h/� RINSEAMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # � K- <br /> -OR- OTHER:; <br /> I V VAPORS PURGED N) <br /> A METHOD�, <br /> -/3D ', AMOUNT USED. u 3 <br /> p L•.E- L- READING AT REMOVAL (MUST BE ( <br /> i <br /> O <br /> T I R COMMENTS <br /> N ! TANK MATERIAL TEE <br /> C <br /> K , F i 9ERGLASS, OTHER)!! TANK S I Z E <br /> O 1 TANK CONDITION <br /> f ,V (GOOD, QO HOLES) <br /> PIPE MATERIALSTEEi <br /> P 1 T , FIBERGLAS-z, OTHER) j ! FEET r <br /> I f PIPING CONDITION (GOODHOLES) <br /> N I , POOR <br /> DEPTH SOIL TYPE <br /> T OBSERVATION <br /> El <br /> c q `/a ) I SAMPLE # <br /> 51 <br /> EXCAVATIO : � X <br /> S N SIZEFO ' <br /> - X YDS OF SOIL: � <br /> M P DEPT SQ <br /> d 3 <br /> OIL TYPE OPSERV ON <br /> i S p I SAMPLE # <br /> P ( L P a <br /> c f I E <br />, G N <br />� T G TRENCH DIMENSION <br /> I X X <br /> YDS OF S <br /> Q H DEPTH TO <br /> FT SAMPL I NG METHOD mss' <br /> 0 4 OF HOURS SINCcDEWATERI� � <br /> NG: <br /> f OTHER SAMPLE.- <br /> LABORATORY S- <br /> cI <br /> G-- <br /> SAMPLERS NAME: �-� <br /> CLOSURE IN PLACE, MIXTURE: ��'� <br /> �., VOLUME: <br /> ' <br /> '043 ( 30/89) DRAW c ITLc <br /> MAA ON REVERSE, q 4 <br />