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PHS-EHD - UNDERGROU9 TANK CLOSURE/ABANDONMF'4=TqtSPECTION <br /> (SHADED AREA T` 3E FILLED IN FOR THE FIRS P 1D <br /> p �,�/y't�yA yNpyK ONLY) <br /> fAV <br /> 5 K a1✓ SRF_ ��F �. IlAtz0 1v w <br /> E OWNER NAME 1" OWNER PHONE # �Z / <br />'k3 <br /> N CONTRACTOR - .�N�R�°c <br /> F CON. PHONE# <br /> R 5JLHD PERMIT # 6A FI GE` M # 3 3 I <br /> ` A' ' I <br /> L t J <br /> IN5PECT0 DATE//,7-� a TANK # 2'c) - <br /> rr <br /> R R I NSED N) METHO - i 'u-;;l /) h 5Ci RINSE AMOUNT v <br /> N RINSATE DISPOSAL SITE �`� tp <br /> S <br /> E MANIFEST # -OR- OTHER <br /> A VAPORS PURGED <br /> ON) <br /> �`QAMOUNT USED 1Zib <br /> t' P L. E. L. READING AT REMOVAL (MUST BE D'Lr L <br /> I" T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, OTHER) TANK SIZE <br /> t K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) /f <br />{. N c <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> P T J <br /> I PIPING CONDITION (GOOD, POO , HOL 5) v / ;:pN - <br /> G DEPTH SOIL TYPE 013SERVATYgN <br /> T SAMPLE # <br /> F A <br /> I N <br /> . E K <br /> L _ <br /> D EXCAVATION SIZE: mllX X ,� <br /> SOIL: <br /> I ADEPTH SOIL TYPE OBSERVATION <br /> s N M P SAMPLE # <br /> S P I — <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SAIL <br /> cvx <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N i <br /> 0 # . OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> - <br /> LABORATORY: - SAMPLERS NAME <br /> CLOSURE IN PLACE IXTURC: VOLUME: 1./eVA-wd �S <br /> :H 2-3043 (10/89) DRAW SITE MAP ON REVERSE <br />