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E <br />N <br />E <br />R <br />A <br />L <br />T <br />A <br />N <br />K <br />A <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />N <br />S <br />P <br />E <br />C <br />PHS-EHD - UNDE ROUND TANK CLOSURE/ABANDDJALENT INSPECTION <br />(SHADED ARE BE FILLED IN FOR THE FIV TANK ONLY) <br />1PRIPP <br />4rvn,,, Aepof <br />OWNER NAME I I OWNER PHONE # <br />S Arm -w .209- <br />cx <br />CONTRACTOR CON. PHONE# <br />SJLHD PERMIT # EPA <br />....... . ........ ............ g Ski 002cy:U I FIRE PERMIT# <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 : <br />R J1 COMMENTS <br />TANK MATERIAL,(STEEL FIBERGLASS, OTHER) <br />ET-E7L FIBERGLASS, <br />0 TANK CONDITION kGOOD, POOR, HOLES) <br />]N <br />S <br />S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) <br />T <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />11 <br />DEPTH J SOIL TYPE OBSERVATION <br />S <br />A <br />M <br />P <br />L <br />I <br />N <br />T <br />A <br />N <br />K <br />P <br />I <br />P <br />E <br />N <br />EXCAVATION SIZE: X z <br />DEPTH I SOIL TYPE [ OBSERVATION <br />0 <br />TANK SIZE fllm-%lv 0, <br />1.2, 600 <br /># FEET <br />YDS OF' SOIL: <br />G TRENCH DIMENSION X X YDS OF SOIL <br />0 H DEPTH TO G. W.: FT SAMPLING METHOD <br />N 2 - I <br />T <br />DR <br />E <br />E <br />DEPTH I <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY <br />A <br />ORATORY: <br />LL LAB SAMPLERS NAME: <br />L.11 CLOSURE IN PLACE MIXTURE:VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />SAMPLE # <br />SAMPLE # <br />WIAS <br />— 1 "flit-ur%firl Y ULu:7UKL <br />INSPECTORc <br />DATE <br />TANK # 39 <br />- JF <br />R <br />RINSED <br />(Y <br />METHOD <br />RINSE AMOUNT <br />N <br />RINSATE <br />DISPOSAL SITE <br />S <br />E <br />MANIFEST <br /># -OR- OTHER <br />Cbl-f4sa^1 <br />V <br />f% <br />VAPORS <br />7-7 <br />PURGED (�)N) METHOD /)7.1- r <br />AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 : <br />R J1 COMMENTS <br />TANK MATERIAL,(STEEL FIBERGLASS, OTHER) <br />ET-E7L FIBERGLASS, <br />0 TANK CONDITION kGOOD, POOR, HOLES) <br />]N <br />S <br />S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) <br />T <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />11 <br />DEPTH J SOIL TYPE OBSERVATION <br />S <br />A <br />M <br />P <br />L <br />I <br />N <br />T <br />A <br />N <br />K <br />P <br />I <br />P <br />E <br />N <br />EXCAVATION SIZE: X z <br />DEPTH I SOIL TYPE [ OBSERVATION <br />0 <br />TANK SIZE fllm-%lv 0, <br />1.2, 600 <br /># FEET <br />YDS OF' SOIL: <br />G TRENCH DIMENSION X X YDS OF SOIL <br />0 H DEPTH TO G. W.: FT SAMPLING METHOD <br />N 2 - I <br />T <br />DR <br />E <br />E <br />DEPTH I <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY <br />A <br />ORATORY: <br />LL LAB SAMPLERS NAME: <br />L.11 CLOSURE IN PLACE MIXTURE:VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />SAMPLE # <br />SAMPLE # <br />WIAS <br />