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j _v.sl <br /> PHS-EHD - UNDERIL BUND TANK CLOSURE/ABANDONI**s4i INSPECTION <br /> (SHADED AREA;;TV BE FILLED IN FOR THE FIRST TANK ONLY) <br /> VAVA <br /> Nk/rte Siva/ dd tc%. <br /> OWNER• NAp <br /> AME�-�oc�k-}o '� <br /> E 1. d kol p OWNER PHONE <br /> N CONTRACTOR S�rvr'iC CON. PHONE# <br /> E �� -y6�1` -8333 <br /> R SJLHD PERMIT # EPA <br /> A•' 4 " cyo "'a FIRE PERMIT # ` <br /> L <br /> INSPECTOR e' Ila,/ DATE /moo TANK # 39 - /5*78 _ 2- <br /> R <br /> R RINSED ,(Yo <br /> I METHOD INSE AMOUNT <br /> N�• <br /> N RINSATE DISPOSAL SITE <br /> S N 1� <br /> E MANIFEST # $1 .20 3 -OR- OTHER <br /> 6 k mg, <br /> AV VAPORS PURGED (Y N) METHOD <br /> AMOUNT USED <br /> P L.-E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEEL FIBERGLASS, OTHER) TANK SIZE n <br /> K C d�OD di�..c,e <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> �► S PIPE MATERIAL (STEE FIBERGLASS,. OTHER) J_# FEET 3' <br /> P T <br /> I PIPING CONDITION (GOOD POOR, <br /> N HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION C�'ww.. sle- <br /> F T C � rM SAMPLE # <br /> A ,y <br /> I N . o/r i �1 e r r t j- <br /> E KAJO <br /> L 12 <br /> '' •^� „. <br /> D <br /> S EXCAVATION SIZE: .2.13'X X YDS OF SOIL: <br /> I A DEPTH I SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I s0 C <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL _ 4/50 H DEPTH TO G. W. : FT <br /> N 2 SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY= SAMPLERS NAME: � � <br /> `P A%�y JI,�+ISS. i 4d I✓ Ile <br /> CLOSURE IN PLACE MIXTURE: RurS�/ <br /> VOLUME: <br />=H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />