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PHS-EHD - UNDERG` ND TANK CLOSURE/ABANDONME ' INSPECTION <br /> Y�(SHA,yDED��yIAREA <br /> T�L�/;� F�I,yL�yLyE�Dlpy�yI N FOR THE <br /> FIRST <br /> NpyK�y ONLY) <br /> / E�W���!J1iLv7'v�'�"(L�'7y141L� �lvlJi.7iilrr��"YL1Lll�iri0i ��II�1r:7v�� �11i71i7ir""ll"lrrlli!L" �q�rr�.�try�l <br /> E OWNER NAME OWNER PHONE # <br /> ,c <br /> N CONTRACTOR CON. PHONE# <br /> E , <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A ' • P,wvl v 'h <br /> INSPECTOR C• / DATE t��2/9Z TANK # 39 <br /> R RINSED Y N) METHOD RINSE FlMOUN7 <br /> I kk�! c 33co <br /> N RINSATE DISPOSAL SITE <br /> S ' <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A lCe �0 6s <br /> P L.-E.L. READING AT REMOVAL (MUST BE ( 20X) o <br /> 0 �o G £.4. <br /> T R COMMENTS See <br /> A <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C O.OAD d,L. <br /> / 0 TANK CONDITIO (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F• A ' - into/ is <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: _f+ X yo X <br /> S _/� YDS OF SOIL: -7-4,/ S7�k S <br /> I A 1 <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION YDS OF SOIL <br /> I S <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD ` <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: A/Psf labs o/s SAMPLERS NAME: /ylir Kr'►�4^� <br /> CLOSURE IN PLACE MIXTURE: VpLURIE: <br /> EH 23043 (10/69) DRAW SITE MAP ON REVERSE <br />