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PHS-EHD - UNDERGROL TANK CLOSURE/ABANDONMENT _NSPECTION <br /> (SHADED AREA/�yTO,/ BL FILLED I <br /> ILLEDI yN�/ FOR THE FIRS/T/ TANK ONLY) <br /> � 2 7 <br /> E ,f OWNS: NAME�I-- �G OWNER PHONE <br /> �J A <br /> N CONTRACT R i� <br /> E CON. PHONE## <br /> i <br /> R % SJLHD PERMIT # CE F� 0,27776 <br /> A . ' / FIRE PERMIT # <br /> L <br /> J i <br /> - J <br /> INSPECT )Cf DATEI I_Z TANK # .,9 Q <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUN-f <br /> N RINSATE DISPOSAL SI-fE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHOD ?" eX --Z'Ge w <br /> A AMOUNT USED �- <br /> P <br /> L. E. L. <br /> O L. E. L. READING AT REMOVAL (MUST BE ( 2U%) � <br /> T R COMMENTS <br /> AUW��S L�aRra�ra�. <br /> N TANK MA-fERIAL (STEEL, FIBERGLAS <br /> OTHER) TANK 3 1 Z E 0/c, <br /> 6 6 <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> • S F'IF'E MATERIAL <br /> P T (STEEL, IBERGLASS OTHER) )# FEET <br /> I PIPING COND I T I O (GOOD, FLOOR, HOLES) s <br /> N � - <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE I# <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE it <br /> S P I - <br /> T G TRENCH DIM NSI0N X o1` <br /> YDS Of: SOIL �Q <br /> 0 H DEPTH TO G. W. : FT <br /> N SAMPLING ME-fHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: <br /> VULUhIL' <br />:H 23043 (10/s9) DRAW SITE MAP ON REVERSE <br />