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PHS—EHD — UNDF 'OUND TANK CLOSURE/ABANDG" 7 INSPECTION <br /> (SHADED ARE; BE FILLED IN <br /> FOR THE Fi'— TANK ONLY)�,�r <br /> f �� ' 1a ' � �"i�rr"3JiZ�iyH'�v�7u'�uJ�iZiiYliY�iZu 'Cri�a�Y" <br /> �� my /!vf rC;7r�LUcJO S fi lee"( <br /> flC GLS ' <br /> OWNER NAME OWNER PHONE # <br /> E 6l/-- 7SY'Yj-i <br /> N CONTRACTOR ff CON. PHONE# <br /> R SJLHD PERMIT # EPA # �'K' rS71�9v FIRE PERMIT # <br /> A r r <br /> L <br /> INSPECTOR C DATE 11-16LO TANK # 39 -- <br /> R RINSED ON) METHOD � IP rNS� R I NSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> EMANIFE57 # 3-'14(92Q5— --OR— OTHER <br /> V VAPORS PURGED (Y N) METHOD � �P AMOUNT USED CSO <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20X) <br /> O <br /> T R COMMENTS <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE -x`1(7 <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET `,,� <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T ��� r� � SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L y .60 <br /> D - <br /> 5 <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> F <br /> S P I <br /> P L P / <br /> E I E <br /> C N 1 <br />' 7 G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: � <br /> CLOSURE IN PLACE MIXTURE: -T VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />