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I t <br /> J. w r n <br /> RHS-EHD UNDERGk TANK CLOSURE/ABANDONM k.;iSPECTI0N <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> !df/ML!MOWER <br /> 5 <br /> 51 1 G hV 43�it �Y/ 1 <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRA TOR CON. PHONE# <br /> R SJL PERMIT # EPA # FIRE PERMIT # <br /> A a � <br /> L c <br /> j� t M t1J K 1 t N C, 1 1 K <br /> f <br /> INSPECTORktMDATE / TANK # 39 - - <br /> I R RINSED (Y f q)) =METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> i S <br /> E MANIFEST # Z --OR- OTHER <br /> V VAPORS PURGED Y N) METHOD ' AMOUNT USED 6 <br /> A <br /> q ft� . 1 <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) t16L.:5,-O <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) ! TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) (10 <br /> N U <br /> S PIPE MATERIAL (STEEL, FIBERGLASS OTHER) # FEET <br /> P T <br /> E I PIPING CONDITION OQII POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> TI <br /> t emu ' <br /> F A <br /> I N / 1 • r In <br /> E K ! 7o or 15 a <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A 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 X X YDS OF SOIL <br /> I <br /> 0 I H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> I 0 # OF HOURS SINCE DEWATERING: 0` ' <br /> O OTHER SAMPLE: <br /> v <br /> LABORATORY: SAMPLERS NAME: aQ- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: F <br /> EH 2304.?. (10/89) DRAW SITE MAP SN REVERSE <br />