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PHS-EHD - UNDER <br /> ��UwN�D TANK v CLOSURE/ABANDON767b7a� INSPECTION <br /> (SHADEDAREA TBE FILLED IN FOR THE FIIRS TAANKONLY) <br /> T///2 <br /> 21��i� p <br /> Gy� <br /> v vry <br /> OWNER NAMEOWNER PHONE # i <br /> N CONTRACTORS��/�/� D CON. PHONE# { <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR-T vs DATE 5�ap. Q� TANK # 39 <br /> R RINSED (Y N) METHOD RINSE AM NT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER r <br /> V VAPORS PURGED (Y N) METHOD /`<�e AMOUNT USED Q� <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) LF L y 'j 0':�' <br /> 0 <br /> T R COMMENTS im <br /> A <br /> N TANK MATERIAL IFE5, FIBERGLASS, OTHER) TANK SIZE / Q o <br /> K C n <br /> / O TANK. CONDITION (GOOD, O` GR,JHOLES) r, &&J <br /> N � � <br /> S PIPE MATERIA STEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, 'OO OLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION d SAMPLE # <br /> F A h cam- ' Cdhi{�V L <br /> I \ S I <br /> E K !i g J.Q ki jeTb t— <br /> L tr- + i <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A DEPTH $OIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P Ic <br /> P L P <br /> E I E S ? <br /> T G TRENCH DIMENSION L X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. a d FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> o❑ OTHER SAMPLE: <br /> LABORATORY: CLQ SAMPLERS NAME :u4'-I k_ <br /> CLOSURE IN PLAEE7 MIXTURE: U VOLUME: <br /> I <br /> .H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />