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t <br /> • ip <br /> R ' OHS--EHD -- UNDERf ND TANK CLOSURE ABANDONR! INSPECTION <br /> (SHADED AREA rti 4E FILLED IN FOR THE FIRST TANK ONLY) k <br /> OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E CPN. PHONE4t <br /> R . SJLHD PERMIT # EPIA # / <br /> A . FIRE PERMIT # <br /> I NSPECTOR C. DATE T NK # 39 /d 53 4 <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> I �I�u (act �O <br /> N RINSATE DISPOSAL SITE TT <br /> SletP.se a N^h <br /> E MANIFEST # /05 Loge( <br /> L <br /> a2 -❑ -- OTHER' <br /> V VAPORS PURGED {Y/ ) METHOD <br /> AMOUNT USE6`'/.2 lla-1 s. <br /> P L.•E. L. READING AT REMOVAL (MUST BE < AUX) <br /> o <br /> T R COMMENTS <br /> A <br /> 75 <br /> N TANK MA'FERIAE STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION {GOOD POOR, HOLES) <br /> N <br /> PIPE MATERIALSTEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A + C <br /> I �Sc _ a � <br /> N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X b X YDS OF SOI L <br /> I A DEPTH SOIL TYPE OBSERVATION I` <br /> N M P SAMPLE # <br /> S P I <br /> P L P k <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I ..........T YDS O___ S O................................ <br /> IL <br /> O H DEPTH TO G. W. : <br /> N y FT S -MPLING METHOD <br /> li <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: E <br /> CLOSURE IN PLACE MIXTURE: <br /> V£1LUME: .y d <br /> H 23043 ( 10/89) <br /> DRAW SITE MAP ON RE FRSE <br />