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PHS-EHD - UNDERGit 4D TANK CLOSURE/ABANDONMI�-t� INSPECTION <br /> (SHADED AREA TO FILLED IN FOR THE FIRST TANK ONLY) <br /> ''I All lllx�1151051 <br /> r ra rrrrr r rrrarrr ' <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR f,- Foleq DATEcL) TANK # 39 - <br /> R RINSED ( N) METHOD Tr i P(l R I NSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE G� U�t 0i l Q, r.0 <br /> I �T50t _'17e(o <br /> S J <br /> E MANIFEST # f 114Ef3- LQ <br /> V VAPORS PURGED YON) METHOD_J�)rj AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) C)� <br /> 0 <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE i�Q�f� <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A 1- _ <br /> I N <br /> c <br /> E K „ W,O �Z <br /> L , h <br /> D S EXCAVATION SIZE: Jla X -if X YDS OF SOIL: �5(_OS3 <br /> I A DEPTH SOIL TYF' OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> O H DEPTH TO G. W. : Pr�blN FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME:_ <br /> CLOSURE IN PLACE MIXTURE: rJ I VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />