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PHS--EHD - UNDEf SND TANK CLOSURE/ADANDONF•._ ' INSPECTION <br /> (SHADED �yAREA TL,-,BE FILLED IN FOR THE <br /> FIRST'-TANK ONLY) <br /> IC 6-yl <br /> r. i"�ir�ri���.v�i , <br /> ❑WNER- NAME <br /> OWNER P <br /> E HONE # �7 <br /> r.c <br /> N CONTRACTOR �1M�cSi� CCN. PHONE# <br /> E <br /> R SJLHD PERMIT # E ,A # cRc caov f�1n nv; ✓ <br /> A - ? Z8`7 F I RE PERMIT # y�r 'S,cr� <br /> L . , �y�• <br /> INSPECTOR K. F-CLGy DATE 51i.T=f <br /> NK # 29 <br /> R RINSED (YEN) METHOD RINSE AMOUNT ] <br /> N RINSATE DISPOSAL SITEyy�ps <br /> ellS -f )es t - � <br /> E MANIFEST .# - � <br /> ._ _onOTHER Y�! �4- <br /> AV VAPORS PURGED ( N) �kMETHOD ce <br /> AMOUNT USED <br /> P L.-E. L. READING AT REMOVAL (MUST BE ( 20%) � <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL (STEEL) FIBERGLASS, 0 HER) TANK SIZE <br /> K C �� G r4C.t�hJ <br /> / 0 TANK CONDITION (GOOD, POdR� HOLES) <br /> N <br /> S RIPE MATERIALSTEEL, FIBERGLASS, q HER) I It FEET <br /> P T <br /> I PIPING CONDITION (GOOD, OpR� HOLES <br /> N CorrGsf U'vi e d. vLln7f-- <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T F SAMPLE # <br /> F A _t <br /> I (y ! <br /> L K <br /> D EXCAVATION SIZE: -:2z, X � X <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPEORSERVAT10 �T rp"'ilt�Q on-, fK SAMPLE # <br /> N M <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X ?a <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; SAMPLING METHOD ... <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: :IV) <br /> VOLUME: N f� <br />.H 2-0 (10/89) DRAW SITE MAP ON RE FRSE f <br />