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I <br />PHS-EHD - UNDEJ UND TANK CLOSURE/ABANDON & T INSPECTION *Now* <br />(SHADED AREA BE FILLED IN FOR THE FIRST TANK ONLY) <br />.......... . .. ...... . <br />r) <br />OWNER-NAME <br />CONTRACTOR <br />WeS4eAr V) <br />• <br />SJLHD PERMIT # <br />r <br />l 19 196 RA. <br />OWNER PHONE #(Z6 c)) Ll H ID'S <br />CON. PHONE# <br />Arl <br />. ......FIRE PERMIT # <br />INSPECTORDATE TANK #603 <br />9 o/ <br />R RINSED Y N) METHODjfte rjtj5,p <br />I RINSE AMOUNT /_50 (7ae <br />N RINSATE DISPOSAL SITE ! _ <br />S ai rie4f +W.5 0,n <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED N) METHOD <br />A - - �Dr AMOUNT USED 116� <br />P L.-E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 <br />R COMMENTS <br />TANK MATERIAL STE FIBERGLASS I , OTHER) Mv <br />c TANK SIZE 1010006-7cj <br />0 TANK CONDITION (GOOD, POOR HOLES) <br />N �%YrO,51 1010 Jk4'X <br />S PIPE ,IMATERIAL (STEE , FIBERGLASS, OTHER) <br />T # FEET <br />z - <br />PIPING CONDITION (GOOD, POOR <br />T <br />E <br />STIL TYPE OBS55VATIOv,%�_ SAMPLE # <br />s 0 0 0 <br />A A7a kv-4n <br />N <br />K <br />X AVATION SI EN <br />X <br />S X '3z' YDS OF SOIL: C- <br />A DEPTH SOIL TYPE OBSERVATION <br />M P SAMPLE # <br />L P LIMA'I <br />I E "0 gh, <br />N <br />G TRENCH DIMENSION X - L X 102 YDS OF SOIL I <br />H DEPTH TO S.W.: <br />2 — FT SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY:o eo An 0, 1 ERS NAME: <br />CLOSURE IN PLACE MIXTURE: 47 d <br />VOLUME: <br />1 213043 (10/89) non" qy 6v <br />lr_ Ill-ili ON REVERSE <br />