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PHS-EBD - UNDERdf <br /> VD TANK CLOSURE/ABANDONMElINSPECTION <br /> (SHADED AREA TO aE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER. NAME _ OWNER PHONE # <br /> a3j -a-7/ � <br /> NCONTRACTOR CON. PHONE# <br /> E � �:� C; Sf uc. i�� araq - $3S- <br /> R SJLHD, PERMIT # y EPA # FIRE PERMIT <br /> L � <br /> j <br /> INSPECTOR � DATE /da� TANK # 39 <br /> R I RINSEDY N) METHOD spm RINSE AMOUNT ., ,SS <br /> I u 1wf <br /> N . RINSATE DISPOSAL SITE <br /> S Gl A <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED &N) METHOD AMOUNT USED <br /> A Ec e 7 - JS-/�S <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20X) >,V!pOZ ' a <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (CrfE , FIBERGLASS, OTHER) TF)NN. SIZE /Q <br /> K C I!f <br /> / D TANK CONDITION 00 POOR, HOLES) <br /> N <br /> 1 S FIFE MATERIAL fEE FIBERGLASS, OTHER) <br /> P T # FEE'f y8 i <br /> I PIPING CONDITION (GOOD,, '0 R HOLES) <br /> N <br /> G <br /> T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F q14 L.v <br /> 4 E K 043 <br /> L <br /> D EXCAVATION SIZE: (r X 3 X <br /> S l.OL YDS OF SOIL: cD Yc/-3 <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I � <br /> P L P <br /> E I E <br /> C N <br /> E T E TRENCH DIMENSION Y� `X a�-� X �� <br /> I _._ 1 YDS OF SD I L 7i <br /> O H DEPTH 7D G. W. : i <br /> N FT SAMPLING METHOD E <br /> U # OF HOURS SINCE DEWATERING: <br /> 00 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> 5 .1-✓pair <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />-H <br /> 23043 ( iG/B9) DRAW SITE MAP ON REVERSE <br /> i . <br />