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PHS-EHD - UND" yOUND TANK CLOSURE/ABAND r�IT INSPECTION <br /> (SHADED ARE `W1 BE FILLED IN FOR THE F—I-J TANK ONLY) <br /> .� c,� L cr F-21L � <br /> OWNER NAME OWNER PHONE #fi`" 3� <br /> �fiYn c� <br /> . S c tw_ fi� — <br /> E (15---'7T_q—y33i-/ <br /> N CONTRACTOR CON. PHONE# 9.0 ' <br /> cirf�� 5 Qu.r Ic�P s M Ice Grp <br /> E <br /> R SJLHD PERMIT # EPA # � 7c FIRE PERMIT # <br /> A - ; <br /> L <br /> INSPECTOR �- �-� DATE i&� TANK # W9 3:��T - .3 <br /> R RINSED ( YON) METHOD �� r RINSEAMOUNT <br /> ieLr <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # S r -OR- OTHER <br /> V VAPOR PURGE (Y/N) METHOD!/T` - P AMOUNT USED <br /> A <br /> G L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS _ <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITIO �OODPOOR, HOLES) <br /> N <br /> ,' S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET,( Q 6 ,w,,J) <br /> P T <br /> I PIPING CONDITION GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATI-O! SAMPLE # <br /> F A _` ��r �b9 '� `= <br /> I N -� <br />' E K <br /> L <br /> D EXCAVATION SIZE: `31 X 7' X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATIONSAMPLE SAMPLE # <br /> N M P <br /> S P I <br /> i P L P f <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X . YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : _ FT SAMPLING METHOD <br /> N i <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH '3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />