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PHS—EHD — UNDERGr6-✓,D TANK CLOSURE/ABANDONMEV� INSPECTION <br /> (=HPDED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> %�l✓ursrrulvr r'�'3,�!1'G.�,!/<X��Ar�"�'r,!/r30� � �/iiYl/d".t/i�/r},'!/if7/..�1/ <br /> ' <br /> S1 1 {�u�>i� aviuuauialaiaraururvrruururruiuurw.wurururili ��f/•,!•�f/ , , f/•;pD•f' !/rYY•fl/i�1/rrr0D,.�G/Y/ i <br /> � 1 � i . ,��ur�,rrraiuia/.vurruururiaiui.Gurur r�r�ruwurcvururraururmcvruur«, <br /> c f OWNER NAME � <br /> E ;/ f 1 D CL�� C`�C.�V OWNER PHONE # (9g,) <br /> N CONTRACTOR / <br /> t& I fit CON. PHONE# f/ <br /> R % SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L i K 1 U uK <br /> INSPECTOR DATE r TANK # ?,9 <br /> . T—METHOD-7-�_ f <br /> R RINSED (Y)N) ' <br /> I <br /> � RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> i E MANIFEST # V :--OR- OTHER i <br /> fi <br /> V VAPORS PURGED .(Y N) METHOD AMOUNT USED <br /> P` L. E. L. READING AT REMOVAL (MUST BE J< cOX) <br /> o <br /> T R COMMENTS <br /> A <br /> N ; TANK MATERIAL TEEL,,' FIBERGLASS, OTHER) TANK SIZE <br /> K + C I <br /> 0 TANK, CONDITION (GOOD, Pte_®R J HOLES) <br /> . I S PIPE MATERIAL ESTE FIBERGLASS, OTHER) # FEET <br /> P I T ( <br /> I I i PIPING CONDITION (GOOD, POOR, HOLES) I <br /> N <br /> s ( DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F <br /> A d' i <br /> I i N <br /> E 5f ni 4 <br /> L I I <br /> D EXCAVATION SIZE: C� X X "1 YDS OF SOIL: <br /> S <br /> I A ' DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N ! M P ' <br /> � <br /> L P ( <br /> I E <br /> C N I <br /> T G i TRENCH D I MENS i CN r X <br /> I i —�- �Z X YDS OF SOIL 5 "�( •`�- �-i c� <br /> 0 I -H DEPTH TO S. W. : FT � SAMPLING METHOD � <br /> N I 1 2 I <br /> f U # OF HOURS SINCE DEWATERING: <br /> i I <br /> Elf OTHER SAMPLE-: <br /> [�i TL7B�=AT�RY=:�rto <br /> Ce 4 �t CQ�, , SAMPLERS NAME: <br /> CLOSURE iN GLAC` MIXTURE: E VOLUME: <br /> ; ii <br /> 1AG GN REVERSE <br />