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PHS--EHD - UNDF ROUND TANK CLOSURE/ABANDC NT INSPECTION <br /> (SHADED AREi�O BE FILLED IN FOR THE Fl iT TANK ONLY) <br /> s,jNOR off Ff A- M, 111211i , <br /> •<N lac � —712 E' 61e,"e— _k v j <br /> E OWNER- NAME S � PHONE # <br /> N CONTRACTOR CON. PHONE# M <br /> E " s s s. -. <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A - <br /> L <br /> J ' <br /> INSPECTOR uM� DATE 'o TANK # 39 <br /> LE <br /> RINSED ( /N METHOD R I NSE "AMOUNT �-- <br /> • RINSATE DISPOSAL SITE <br /> MANIFEST # -OR- OTHER E'rick�v 3 <br /> V VAPORS PURGED �y ) METHODS AMOUNT USED <br /> A � f <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) �r- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL <br /> (GOFIBERGLASS, OTHER) TANK SIZE L/ <br /> K C <br /> / 0 TANK CONDITION OD, POOR, HOLES) <br /> N �o <br /> 1 S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET / <br /> P T `JI <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH 'SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A f lau WdaLla ,teacylncek,tellv'-j p, <br /> I N 3 a <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X YDS OF SOIL: <br /> 2 <br /> I A DEPTH SOIL TYPE OBSERVATION siqr4ILE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �'q,�o,.,�� by SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />