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PHS-EHD - UNDER :UND TANK CLOSURE/ABANDON�.T INSPECTION (�/ iJtz <br /> (SHADED AREA BE FILLED IN FOR THE FIR 'TANK ONLY) <br /> In WWI. <br /> OWNER NAME G.h21 w�'S �O, OWNER PHONE /# 1C�SZ-( � <br /> E <br /> N CONTRACTOR CON. PHONE# /7, , <br /> E11 ! <br /> R SJLHD PERMIT # — EPA # FIRE PERMIT <br /> �ci o ( <br /> A <br /> L JL — <br /> INSPECTOR DATE TANK # 39 - <br /> R RINSED (Y/N) METHOD 1FY RINSE AMOUNT<�00 <br /> N RINSATE DISPOSAL SITE ClrC6bL TDt,nL ('.( ? � <br /> S <br /> E MANIFEST # I��G �,^ <br /> V VAPORS PURGED ,Y1/N) METHOD Ley . �_ u AMOUNT USED <br /> A �- >1TP_^cz n v p-rl� <br /> P <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20%) J/ <br /> 0 < <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL C�TEEU, FIBERGLASS, OTHER) TANK SIZE <br /> K C — - <br /> / 0 TANK CONDITION (G00D,_ t�00-R4 <br /> N ' HOLES) <br /> n <br /> S PIPE MATERIAL"(STEELY FIBERGLY , OTHER) # FEET r` K•� <br /> P T - _ <br /> I PIPING CONDITION (GOOD,—POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A `t Z1,w vote v _ <br /> I N ( '�O O nfF 3 <br /> E {( <br /> L <br /> D EXCAVATION SIZE: I X � X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M p <br /> S P I " .. GA/Q� ✓Bc�/ f /. <br /> P L P J /n i Z a-y � ( Ji f�1 r I Z -2 s ' S,. <br /> E I E / C N(r h' CXL`7T q r - 6 <br /> C N 5 Q 5C-. C i °o T2 0 taCc d <br /> T G TRENCH DIMENSION YDS OF SOIL <br /> I — <br /> O H DEPTH TO G. W. w FT SAMPLING METHOD — <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: — <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE : VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />