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PHS--EHD - UNDERAUND TANK CLOSURE/ABANDONS T INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE FIRS TANK ONLY) <br /> FRI ,r ��i� V/V4 ivur <br /> E OWNER NAME L/D",,, Q - � OWNER PHONE # <br /> N CONTRACTOR CO CON, PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT <br /> A <br /> L p <br /> INSPECTOR te7t- ' DATE 1�3� �! TANK # 39 <br /> R RINSED Q/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> s <br /> E MANIFEST # -OR- OTHER ' <br /> A —F— <br /> V VAPORS PURGED Y N) METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> i T R COMMENTS <br />} A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C ' <br /> a / 0 TANK CONDITION (GOOD POO HOLES) <br /> 3 N ags -feta 101,s;6 le <br /> 9 <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET S- f -,p-T <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />' T <br /> F A . ? 5 a,-f% S �n Ga�l.(.tiv� 0 <br />. I N <br /> E K C <br /> L <br /> D EXCAVATION SIZE: '_L._ X I3 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 . 11 TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 4 # OF HOURS SINCE DEWATERING: <br /> 0OTHER SAMPLE: <br /> EBORATORY: W W ka-� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />