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E ' <br /> PHS—EHD — UNDERGR D TANK CLOSURE/ABANDONMENIJ NSPECTION <br /> ,(SHADED Ar/7REA1y TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> MIR <br /> �vrirrr1tY;`�'( ,urrura rvra ivuriaururarirrurur rvcv ar ,rrr .cv vra aiir viv aiv yr ,�rrr vra �tarvniiuur <br /> I" o- br -+c3r, o <br /> it OWNER NAMEOWNER. PHONE <br /> E <br /> ECONTRACTOR--flIDr C CON. PHONE# <br /> R SJLH PERMIT # EPA # �Z FIRE PERMIT # �3 <br /> A <br /> 's L ti <br /> i <br /> I N -7— <br /> SPECTO&OM 1 dtt DATE -1// TANK # 39 — <br /> R RINSED VYN) METHOD-/1 � ori <br /> RINSE AMOUNTZ(,� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> I` E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED ON) METHOD�r �L+�� AMOUNT USED 3 l-b <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( .2Q%) <br /> O <br /> T R COMMENTS <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE C <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N r Sl�h W a 5 <br /> blah u.�da�.ka � sr v� <br /> y,•. S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) p� '?1 (pt y ��b C U) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T I <br /> 7, yw <br /> A 3 <br /> � PD <br /> I N ` IEta— <br /> ( S b <br /> 441 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X T7 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 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 11 OTHER SAMPLE: tw "vv <br /> LABORATORY: '� �}� SAMPLERS NAME: P=-Dn <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />