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�► s-,r, 7 <br /> PMS—EHD — UNDERGROL TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> "kj I v 6 J JJ[(/!/!df//� �///C4/ iY h '�ii <br /> ?� 7 <br /> E OWNER !NAME �� G�. OWNER PHONE # a55 /S3 <br /> CCONTRACTOR/'IL . J e CON. PHONE# <br /> R y��% SJLHD PERMIT # r�'v ' <br /> A • G EPA # FI <br /> J <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N PINSATE DISPOSAL SITE <br /> S r <br /> E MANIFEST # <br /> —OR— OTHER <br /> V VAPORS PURGED /(Y N) METHOD ` <br /> A AMOUNT USED <br /> L.E. L. READING AT REMOVAL (MUST BE ( C. �� <br /> O � ^ <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C G <br /> / O TANK CONDITION (GOOD F'00 <br /> N S) <br /> y S PIPE MATERIAL (STEEL, IBERGLAS , OTHER) # FEET ~ <br /> P T h <br /> I PIPING CONDITION <br /> N (GOOD PO R, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION oa> <br /> T SAMPLE # ,� <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 # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T Gr TRENCH DIMENSION <br /> I X X YDS Of= SOIL <br /> 0 H DEPTH TO <br /> N i ' ' FT SAMPLING ME'f HOD <br /> 0 # OF, ' HOURS INCE DEWATERING: <br /> I - <br /> / 0 OTHER SAMP <br /> LABORATORY: \ <br /> SAMPLER; NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />:H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />