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RHS—EHD — UNDER( UND TANK CLOSURE/ABANDONP, T INSPECTION <br /> (SHADED AREA TU BE FILLED IN FOR THE FIRST TANK ONLY) <br /> .� OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> AR SJLHD PERMIT # EFFIRE PERMIT'A # ` <br /> # <br /> INSPECTOR �: . - DATE TANK # 3 - � - <br /> R RINSED 1(Y/N) METHOD RINSE AMUUN-r <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # ?/r —OR— OTHER <br /> V VAPORS PURGED Y/N> METHOD C i <br /> A 51 c AMOUNT USED <br /> L. E. L. READING AT REMOVAL (MUST BE ( OU%) �l v <br /> 0 <br /> T R COMMENTS - <br /> A <br /> K C TANK MATERIAL (fSTEEL, FIBERGLASS, OTHER) TF►NK SIZE CJ�L,c)o <br /> / 0 TANK CONDITION (GOOD, F='OOR� HOLES) Cab V G\)5- Ccrrrc75 �� <br /> N _.- <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET C,,ne <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) (X1!1 ^L� f, � ,; �0 L, <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A ' +- y ?r- <br /> E K � �_' 9 <br /> DS EXCAVATION SIZE: �, X .77 X YDS OF SOIL• <br /> I A DEPTH SOIL TYPE OBSERVATION ` <br /> N M P SAMPLE tt <br /> S P I may' bv� v <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : �� n �+ � FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY:;-NE I <br /> k'; 'C+ , '-C F �,L-,.,i,— ra �, SAMPLERS NAME: f�i�e-1 (r4Pn�c� vie. <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH32043 ( 10/69) DRAW SITE MAP ON REVERS= <br />