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PHS-EBD - UNDER ;.D TANK CLOSURE/ABANDON ^I� �INSPECTION i <br /> (SHADED AREA :`.. FILLED IN FOR THE FIR ` RNK ONLY) <br /> AM 6M 52 M109 woo, :111�!?!:! <br /> 2,�YIAVAZWIMIAVZ it <br /> % v� rte.' �.4- ✓C/r % .�Ql/ /�!-:i�v .mac%fry n %l�; <br /> OWNER NAME . .- OWNER , RHONE # <br /> E <br /> N . , CONTRACTk]fR CON. PHONE# �'1J <br /> 3 --Z3 <br /> R SJLHD PERMIT # EPA # h �- Z, ' FIRE PERMIT # <br /> A <br /> INSPECTOR C' v�� DATE 3�S/g TANG, # 329 - i5- 74,1— <br /> R 1 RINSED (Y/ ); METHOD RINSE AMOUNT <br /> r �1 <br /> N RINSATE DISPOSAL SITE <br /> S �Gn UCS dit�Sc.ub <br /> E MANIFEST # -OR- OTHER <br /> f <br /> V VAPORS PURGED &/N) METHOD f� AMOUNT USED <br /> A <br /> P 1 L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEEL FIBERGLASS, OTHER) TANK' SIZE <br /> K C 5 �Lw sr,�P <br /> / O TANK CONDITION (GOOD, OO , HOLES) <br /> N <br /> r S PIPE MATERIAL (S EL,'JU15ERGLASS, OTHER) # FEET tU <br /> P T <br /> I PIPING CONDITION G POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE ## <br /> T <br /> F A <br /> I - N <br /> E K <br /> L <br /> D EXCAVATION SIZE: ��X -7, X YDS OF 50IL: <br /> s �S <br /> I A DEPTH SOIL TYPE OBSERVATION .`~ SAMPLE # <br /> N M P <br /> S P I 1 <br /> P L P / <br /> E I E ' <br /> C N 7- <br /> T G TRENCH D I MENS I ON %'X X YD �50 I L `7 <br /> I - <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N ` <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: F6 SAMPLERS NAf*1E: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> -H :304- ( 10/89) DRAW SITE MAP ON REVERSE <br />