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PHS—EHD — UNDE i VD TANK. CLOSURE/ABANDON INSPECTION <br /> (SHADED AREA i'u BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �`riar"` l�'� rararaiara uriaiaraariaarrrrwurur r .urcvrair H fr� r rrrrSuraiar aarirrcvurrvr�riaiurrrrirrvs�:�iuiar✓Ja/� low <br /> lac% <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR _ CON. r--HONE# v�J <br /> E c��oc,/c�r, Sc>�-urie sf� ur S/G;ey <br /> R SJLHD PERMIT # EPA # � Cc�U SSS FIRE PERMIT # <br /> L ACi rr H r / lil//1 r ,cv. <br /> INSPECTOR [' c'z_-- DATE TANK. # 39 — r S -7 O / <br /> R RINSED (Y N} METHOD RINSE AMOUNT <br /> I E <br /> N RINSATE DISPOSAL SITE <br /> S 47 c:fC S <br /> E MANIFEST # --OR— OTHER <br /> V VAPORS PURGED /N) METHOD AMOUNT USED } <br /> A dry r�c lS�/S <br /> P L. E. L. READING AT REMOVAL (MUST BE C EU%) <br /> 0 <br /> T R COMMENTS <br /> A + <br /> N TANK MATERIAL FIBERGLASS, OTHER) TANK SIZE Ke.vSC *,-a <br /> K C �.avca <br /> / 0 TANK CONDITION (GOOD, HOLESY <br /> N � <br /> S PIPE MATERIAL S EL, FIBERGLASS, OTHER) # FEET �p <br /> P T <br /> I PIPING CONDIT N ( OD, POOR, HOLES) <br /> N <br /> G DEPTH 'SOIL TYPE OBSERVATION SAMPLE # <br /> T r <br /> F <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: FL X X YDS OF SOIL; <br /> S <br /> i A DEPTH SOIL ;YP ❑BSERtiATION SAMPLE # <br /> N M T / <br /> S P <br /> P L / �' <br /> E <br /> C N r <br /> T G G TRENCH DIMENSIONX X YDS OF SOIL <br /> I 7 <br /> 0 H DEPTH TO G. W. : FT ;SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: rC�L SAMPLERS NAME: r-, s <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> ( 10/89) DRAW SITE MAG ON REVERSE <br />