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PHS-EHD - UNROUND TANK CLOSURE/ABAN NT INSPECTION <br />(SHADED AR TO BE FILLED IN FOR THE F T TANK ONLY) <br />ps <br />471"y <br />OWNER NAME <br />E 14 OWNER PHONE # <br />N CONTRACTOR, <br />E CON. PHONE# "-115� 7-5-V - <br />R SJLHD PERMIT #E <br />FIRE PERMIT # <br />A. <br />L <br />INSPECTOR L -DATE TANK # 39 <br />R RINSED (514) METHODjj� <br />Iq RINSE AMOUNT <br />N RINSATE DISPOSAL SITE <br />S <br />r - <br />E MANIFEST # _??'_y60905_ -OR- OTHER <br />AV VAPORS PURGED(3yN) METHOD E AMOUNT - USED <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />A <br />- <br />N TANK MATERIAL (( !TE �' FIBERGLASS, OTHER) ANK SIZE FT 5,000 <br />K C <br />0 TANK CONDITIO (00'0' OOR, HOLES) <br />N <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) #1 FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) Ll <br />N <br />G I DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />/A <br />T DEPTH <br />s' <br />F A co <br />I N 6�) <br />E K <br />L <br />R'vrillulm S af <br />r A A x 7JT- yUbLJF bUIL: <br />S CC= <br />A DEPTH SOIL TYPE OBSERVA <br />N M P SAMPLE # <br />S P I <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X X OF SOIL <br />I I — - <br />0 H DEPTH TO G. ____ FT SAMPLING METHOD <br />N 2 _ 1 711-1 <br />0 # OF HOURS SINCE DEWATERING: <br />TRENCH <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: FTc7k <br />Lee <br />CLOSURE I PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />