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PHS-EHD - UNDERUND TANK CLOSURE/ABANDON*T INSPECTION <br /> (SHADEyD� AREA <br /> TfBBEFILLED <br /> I N FOR THE FIRST TANK ONLY) <br /> E OWNER- NAME ` OWNER PHONE # <br /> N CONTRACTOR -/ CON. PHONE# <br /> E �_- <br /> RSJLHD PERMIT # EPA--# FIRE PERMIT <br /> A # -3v 55Jr" <br /> ' <br /> L �iww*.OrwMaj <br /> INSPECTOR DATE DATEa 7r�� TANK # 39 - aZ 50 .3 - CJ <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> -j— <br /> V VAPORS PURGED 6�N) METHOD � AMOUNT USED <br /> A <br /> P L.E. L. READING AT REMOVAL (MUST BE <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER> TANK SIZE 600 <br /> K C <br /> / 0 TANK CONDITION 00 , POOR, HOLES) ��j,�� % jl/aiQJ <br /> N _ <br /> Y S PIPE MATERIAL d6iEEL FIBERGLASS, OTHER) # 'EE_ <br /> T <br /> P T <br /> I PIPING CONDITION (GOOD, 00 HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N . <br /> E K 1� I ct <br /> L _l!) <br /> D <br /> S EXCAVATION SIZE: X 4— X ,� YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> I T G TRENCH DIMENSION X X YDS OF SOIL <br /> � I <br /> 0 H DEPTH TO G. W. <br /> N FT SAMPLING METHOD <br /> i U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUPIE: <br /> EH 22043 (10/89) DRAW SITE MAP ON REVERSE <br />