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PHS-EHD - UNDER r1UND TANK CLOSURE/ABANDON INSPECTION v <br /> (SHADEDAREA BEF�ILLEG/DIyN� �FOR THE FIR <br /> yT��AN�yKpypONLY) <br /> /��E ��"1uJYI Grlii"7 "Ju'7u��lwivAi '7u 13 �u��Ia'7v"7uNJ1%Yu'I a7L7o"ybi7iYu <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# i <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # i <br /> A <br /> L <br /> INSPECTORL DATE ( ��� TANK # 39 - <br /> R RINSED (('Y/N) METHOD RINSE AMOUNT -6z PC), C <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # j f�71L22 -OR- OTHER <br /> V VAPORS PURGED �`YeN) METHOD r)✓-L\ ( CC AMOUNT USED ` ""� <br /> A I c~-'L, � c� ') <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> �/� <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MRTERIAL! (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C fit, <br /> / O TANK CONDITION (GOOD, FOO R./ HOLES) <br /> N — <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEETc <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) 1 ' G_ TD ( oL� J <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T �, <br /> F A - — 4y <br /> I N �+ / i �' n 5 C'o r J175 1r J <br /> E K <br /> L <br /> DS EXCAVATION SIZE: X 32-1 XYDS OF SOIL: ��?S' <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I 01,x;;,` ✓ c e %2�c . <br /> P L P <br /> E I E <br /> C N - <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : r'Srr r FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: _ <br /> O OTHER SAMPLE: — <br /> LABORATORY: 'METSAMPLERS NAME: it�' c1 Ln'lIe <br /> CLOSURE IN PLACE MIXTURE: Nkq-L VOLUME: N rt- <br /> EH <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />