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FHS-EHD - UNDERGR 1D TANK CLOSURE/ABANDONMEi INSPECTION <br /> yJ, (SHADED AREA TO FlryI L L�ED/���INJ/J//yFOR THE FIRST . -4NK ONLY) <br /> F"MR1 �//X//Y//Y//Y� �%/.•Y Y IYr /Y <br /> /daf✓!!/K <br /> � V *' '✓ i �� i f, i' ;� I Ali. 1-iL <br /> V OWNER NAME OWNER PHONE # <br /> � c y <br /> N CONTRACTOR ,� ' f ' CON. PHONE# <br /> E ' ' <br /> R S.ILHD PERMIT ## �`� ��' EPA #(� ���`�' FIRE PERMIT # <br /> i/ri !/i d�/ / G,GiGG ✓ G ' � G � � / i i i <br /> I L V; ,K17"W"e. �. u rc 1 i � r% l <br /> I j INSPECTOR DATEl1 TANK # 39 <br /> i <br /> R RINSED r(Y/N) METHOD , RINSE AMOUNT <br /> i I N RINSATE DISPOSAL SITE > >� 85C7�z-Tires -!N7-> " <br /> S <br /> I I E MANIFEST # � Lf:' ", '� �' `��" -QR- OTHER TG 77 <br /> � _ I <br /> V VAPORS PURGED (Y/N) METHOD �C� AMOUNT USED <br /> P I L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 LL <br /> T R COMMENTS <br /> A <br /> N I TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K I C <br /> 0 TANK CONDITION (GOOD, POOR, HOLES)` - <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I l i PIPING CONDITION (GOOD, POOR, HOLES) <br /> j N i <br /> G �� DEFT SOIL TYPE OBSERVATION SAMPLE # I <br /> T <br /> F i A I1 ` - � � + I � / ✓ T t <br /> I L I 1 K <br /> D I EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I I AI DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M I P <br /> S i P I —. <br /> I P L P <br /> ' E I E <br /> C f N <br /> { T i G i TRENCH DIMENSION X X YDS OF SOIL <br /> I� I <br /> i 1 H DEPTH TO G. W. : FT I SAMPLING METHOD <br /> N I <br /> 0 # OF HOURS SINCE DEWATERING: <br /> j I I <br /> 0 OTHER SAMPLE: f x <br /> LABORATORY: C idU 1a �¢Y SAMPLERS NAME:! <br /> CLOSURE IN PLACE MIXTURE: �n `�� ( VOLUME: lc -qy 1' <br /> EH 2_2043' (10/89) DRAW SITE MAP ON REVERSE <br />