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PHS-EHD - UNDERi ;UND TANK CLOSURE/ABANDONK .T TNSF'ECTION /i(�( <br /> (SHADED AREA 1*0 BE FILLED IN FOR THE FIRS-1- TANK ONLY) <br /> OWNER NAME OWNER PHONE # <br /> E ,� I 4h q-S 2-�,-- ( <br /> N CONTRACTOR C CON. PHONE# <br /> E Czc� <br /> u <br /> R •l SJLHD PERMIT # <br /> A r r 9 r r rrr 7T^n fo it <br /> L <br /> INSPECTOR . ' � ,: DATE TANK # 39 - <br /> R <br /> 9 -R RINSED Y/N) METHOD `� "'-fit' " <br /> RINSE AMUUN-f �� <br /> I � <br /> N RINSATE DISPOSAL SITE ( �C7Sb�{ �' =_CL(' ,✓G <br /> S <br /> E MANIFEST # <br /> �Of OTfi�RC �r-� r.• t <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A 7 <br /> P L. E. L. READING AT REMOVAL (MUST BE < 220X) J/ <br /> 0 CI <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, BOOR, HOLES) imp IQY� ��1/ r1 <br /> N V' 1c <br /> S PIPE MATERIAL, FIBERGLA S, O-fHER) F (1� <br /> P T - # EET <br /> I PIPING CONDITION (GOOD, F'OOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T n SAMPLE # <br /> F A <br /> I N © r c <br /> E K Lf# - <br /> L <br /> D S EXCAVATION SIZE: z� X 7SOIL: <br /> X YDS OF 3 <br /> - <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P JL-)j- <br /> P L <br /> G J <br /> T G <br /> TRENCH DIMENSION XCt_ YDS OF SOIL <br /> I -- <br /> 0 H DEPTH TOG. W. <br /> N : FT SAMPLING METHOD <br /> _ <br /> C► # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME : <br /> ft -'-1S ✓✓r'lv. ��CL�,I�, <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: r <br /> EH *L213043 ( 10/89) DRAW SITE MAP ON REVERSE <br />