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PHS - UNDEE D TANK CLOSURE/ABANDOIN ..J INSPECTION , <br /> '(SHADED AREA TO RE FILLED IN FOR THE FIRST TANK ONLY)-- <br /> Mll 1,19 <br /> 110 Awl <br /> (UPM z <br /> L i I weal � 1 <br /> E OWNER NAME OWNER PHONE # <br /> N / CONTRACTOR , CON. PHONE# . <br /> R SJLHD 'PERMIT # EPA # FIRE PERM'IT # <br /> q I III'...r 0. n <br /> A •w r v r r t �Iv - �Ul�r7i`i <br /> INSPECTOR �J �,�� DATE TANK # I - <br /> R RINSED ) AI-D METHOD RINSE AMOUNT <br /> I <br /> S RINSATE DISPOSAL SITE <br /> E MANIFEST # <br /> -OR- OTHER <br /> V -VAPORS PURGED &-'/N) METHOD �. - AMOUNT USED <br /> A re.- -T <br /> P L. E. L. READING AT REMOVAL (MUST RE <br /> o - <br /> T R COMMENTS <br /> Z i;e_l ly kl <br /> N TANK MATERIAL (STEED FIBERGLASS, OTHER) TANK;{ SIZE f'�L Uj� <br /> K C �- �.A { <br /> / O TANK CONDITION (GOOD, �[3pHOLES) <br /> N <br /> Y' S PIPE MATERIAL CC'STEEL', F I BERGLRSS, OTHER) # FEET <br /> P T - <br /> I PIPING CONDITION (GOOD, E7Q , HOLES) <br /> N <br /> G DEPTH ' SOIL TYPE O StRVATION ' SAMPLE # <br /> T <br /> F A Nos��ca <% <br /> I N , 5 ! <br /> E K i <br /> L <br /> D S EXCAVATION SIZE: X � X �� YDS OF SOIL: <br /> I A NTRENCH <br /> SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> nI <br /> P L PE I EIF <br /> C N �IN�r�1 i� . JV G IMENSION 3� X X YDS OF SOILU rs' <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHJOD <br /> G # OF HOURS SINCE DEWATERING- <br /> 9 <br /> EWATERING; <br /> 0 OTHER SAMPLE: <br /> T LABORATORY: �_ SAMPLERS NAME : <br /> y CLOSURE IN PLACE MIXTURE: VOLUME: !I <br /> =H 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />