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i <br /> PHS-EHD -- UNDE IND TANK CLOSURE/ BANDON -� INSPECTION <br /> (SHA�DE,yD� AREAT1,._6E FILLED IN FOR HE,pFIRST'lfAUyNK ONLY) <br /> 11 �7tr��1: 1% <br /> =1H Eaz;,,� 'P 0z E 0 <br /> T,vJir. <br /> OWNER- NAME 1ti OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. HONE# # G' <br /> R SJLHD PERMIT # EF'A # �n�°� F <br /> A . IRE PERMIT # (�,�rhs'G, <br /> L � C.o.� . V)O fF i56LeC) c <br /> L <br /> INSPECTOR DATE TANK # 39 <br /> U <br /> R RINSED (Y' KI) METHOD <br /> I RINSE AMUUN'f-- <br /> `� <br /> N R I NSATE DISPOSAL SITE y, C� �Al 41t"CtSC C <br /> S <br /> E MANIFEST # <br /> OF- OTHER <br /> V VAPORS PURGED (Y N) ;METHOD �-;zAMOUNT USED <br /> P L.-E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N K C <br /> TETANK MATERIAL SEL, FITANK SIZE FIBERGLASS, OTHER) K;U"I77 <br /> �7 il�f tL <br /> / O TANK CONDITION (GOOD, OOR I HOLES) ClOrrortc,­� 9+/I <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, O HER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES <br /> N <br /> G DEPTH SOIL TYPE daSERVATION <br /> T SAMPLE # <br /> F q <br /> I N ' <br /> E K ! <br /> L <br /> D EXCAVATION SIZE: X I[! X ' <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYP - OBSERVATION ��� `�� �� i SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E / <br /> C N f <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SAIL <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: .``"r`` <br /> CLOSURE IN PLACE MIXTURE: VOLUME: N6 <br /> H <br />. 23043 (10/89) DRAW SITE MAP ON RE ERSE <br />