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RHS—EHD — UND' ;OUND TANK CLOSURE/ABAND- T INSPECTION t <br /> (SHADED ARE TO BE FILLED IN FOR THE Fi—:J TANK ONLY) <br /> I 11A,15 Z-�Al-1 '1 54 4 �A� me,/'mm'T"gigIVA <br /> Xk-o <br /> E <br /> i <br /> 1 . OWNER NAME OWNER PHONE # c��o� _ o <br /> Ll. S• 9r�n�, /c.f%.nuc <br /> N CONTRACTD , 1�.: �cl�s CON. PWONE# clj�u 7-5 <br /> R SJLHD PERMIT # EP # FIRE PERMIT <br /> INSPECTOR (- DATE �I/6/ TANK ## 39 <br /> R I RINSED (Y/ ) METHOD/ �; rt,NWP RINSE AMOUNT MVI <br /> N RINSATE DISPOSAL SITE l <br /> S <br /> E MANIFEST # `BOO O —OR— OTHER <br /> —7 <br /> V VAPORS PURGED(�N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> KC TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> / O TANK COND I T I OC(GCD, ODOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G EDEPTiH SOIL TYPE OBSERVATION SDO rrrcZp SAMPLE # <br /> T �� <br /> I N E K it /r .. <br /> L /y ! !. h �r <br /> D <br /> S --- F:;;.- <br /> I A DEPTH SOIL TYPE OBSERVA SAMPLE # <br /> N M P rr <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> I SAMPLING METHOD 2 <br /> -7 SSO DEPTH TO G. W. : FT <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: °f �3/G"`� r-"c <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />