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+ a W- <br /> F � I" <br /> ` PHS—EHD -- UNDEF"u 1D TANK CLOSURE/ABANDON+, INSPECTION , K� <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> '�a�i� tl`�iruuawm�v�wruiuiu�cv.�aaw rruiusirsu suw.crrs w� � rucv ururHrwiufuiar�suiurai' 010121 MRS. I ; <br /> E / OWNER NAME OWNER PHONE # <br /> N CONTRACTOR r CON. PHONE# <br /> E �i <br /> R SJLHD' PERMIT # EPA # FIRE PERMIT # a , <br /> .. a, (� ,,��++ is <br /> / // ,i <br /> pret <br /> LJINSPECTOR , DATE z TANK # ,?.9 — p <br /> — <br /> R RINSED METHOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # —OR-- OTHER I <br /> i <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> F L. E. L. READING AT REMOVAL (MUST BE; `( Eta%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL/ (STEEL; FIBERGLASS, OTHER) TANK, SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POORHOLES) <br /> N _ <br /> r S F'IF'E MATERIAL "STEEL; FIBERGLASS, OTHER) # FEST <br /> P T <br /> I PIPING CONDITION (GOOD; OOR, HOLES) <br /> N <br /> j <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A /; /� ' r .s U! UL3 <br /> I - N <br /> r / 1C I F i� sni <br /> E K sa—.Ale <br /> L <br /> D EXCAVATION SIZE: /c.7X �' X // YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P r <br /> S P I �f jr <br /> P' L P �? r va '--� t i; <br /> E I E <br /> C N <br /> T G i <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> z <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 4- <br /> G # OF HOURS SINCE DEWATERING: <br /> EO <br /> HER SAMPLE: <br /> LABORATORY: �G Z_ SAMPLERS NAME.- <br /> CLOSURE IN PLACE MIXTURE: VOLURIEl : t <br /> I <br /> =H Eti'fy4.3 (10/89) DRAW SITE MAP ON REVERSE <br /> - i <br />