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PHS-EHD - UNDERGPn ND TANK CLOSURE/ABANDONMF INSPECTION <br /> (SHADE,yD� YAREA Ttyyy� F/IyL�xL/ED IN FOR THE <br /> py�FIRRyS`II ?ANK�yONLY) <br /> E����4rJ�ll• vr��"Ili�'rJir��v'IJrL� ''w'7u"7L • '- J'+y':7v�1�i17r.Git�%7L"7.v'JZk'r��.(L" '�'y.�ii��a��v7llL"Jl� . <br /> FIU <br /> E OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON- . PHONE# <br /> E , <br /> R SJLHD PERMIT # EPA # <br /> A . FIRE PERMIT # <br /> L - 4 <br /> INSPECTOR �. N� DATE <br /> IRINSED Y N) METHOD RINSE AMOUNT <br /> y <br /> N RINSATE DISPOSAL SITE <br /> S �r.cksan� <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ( N) METHOD AMOUNT USED joa <br /> A rce /b <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) o <br /> O 0 /o L C L <br /> T R COMMENTS SeQ <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C /0000 w L. <br /> / 0 TANK CONDITION (GOOD, POOR, OLES <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE'f � <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A br S,rY-c O o^ S rrco% u u 3/oF <br /> I N <br /> E K <br /> L eouerFioN 2a ooe c 00. <br /> D EXCAVATION SIZE: /9 X +O X 13 YDS OF SOIL: <br /> S u rfS- CSS <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P I c G I>a ca+. 11v9 oN co d� <br /> P L P Sfrt{e i <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO S. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: k/vrf Lcr,6s Nis C9J SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUDIE: <br /> EH 22043 ( 10/a9) DRAW SITE MAP ON REVERSE <br />