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I <br />T <br />A <br />N <br />K <br />PHS—EHD — UNDO ROUND TANK CLOSURE/ABON9 NT INSPECTION <br />(SHADED AR RW To BE FILLED IN FOR THE F1.29 TANK ONLY) <br />.......................................-- <br />OWNER NAME OWNER PHONE # ce"Avc—+- c';_4_ 4d"ce <br />Armt4 &ja - <br />CONTRACTOR CON. PHONE# zql -4/3-3 <br />- F�rlig 13CAff fr-5 Deolt <br />SJLHD PERMIT # I CA EPA # 157 705-.4,41 <br />FIRE PERMIT # <br />I MI'll'UMAKY <br />INSPECTORC #,,4- DATE <br />TANK # 3-9 <br />R RINSED"Y N) METHODr <br />,�'o/ - <br />T I , & I RINSE AMOUNT_ <br />N I RINSATE DISPOSAL SITE <br />S <br />MANIFEST <br />okl T C.1 <br />OMTCC <br />E C u <br />zi�__ - -OR- OTHER <br />V VAPOR PURGE (Y/N) -METHOD <br />l AMOUNT USED glo 1h.5. <br />A — prI <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 <br />R ]I COMMENTS <br />C TANK MP EL FIBERGLASS, OTHER) <br />-S <br />0 TANK CONDITIOIC (GOOD POOR, HOLES) <br />N 11 <br />x t3 PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />P T <br />I PIPING CONDITION POOR, HOLES) <br />T <br />PIPE <br />MATERIAL r <br />N PIPING jCN <br />G T DEPTH SOIL TYPE OBSERVATIO� <br />A <br />N I - - ------- F77— <br />T <br />F A <br />I N <br />E hKI A .1d, <br />L <br />D <br />S <br />1 11 A <br />N m <br />S P <br />P L <br />E I <br />C N <br />P <br />I <br />P <br />E <br />TANK SIZE_5 <br /># FEET_(4j,,,,e <br />EXCAVATION SIZE: 2' X 27' X //*' I YDS OF SOIL <br />DEPTH SOIL TYPE OBSERVATION - I , rCr�- - <br />I G TRENCH DIMENSION X X <br />I YDS OF SOIL <br />0 H DEPTH TO G. W.: <br />N 2 __ FT SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: L <br />I - -- VOLUME:� <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />SAMPLE # <br />SAMPLE # <br />