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BE ( 20%) <br />V. <br />T PHB—EHD — UNDElitUND TANK CLOSURE/ABANDON411T INSPECTION <br />(SHADED AREA . BE FILLED IN FOR THE FIRS TANK ONLY) <br />riggirkeffilffifeargifiNEZIONFSZE2111 Sigtffirlf <br />OWNER. NAME OWNER PHONE # <br />CONTRACTOR CON. PHONE# <br />SJLHD PERMIT # <br />L <br />A if <br />EPA # FIRE PERMIT # <br />r/ AYP/AA / / <br />INSPECTOR/2.1 DATE /VV (...) TANK # 39 — 42 — <br />RINSED / IN) METHODc— <br />/, tc' RINSE AMOUNT <br />RINSATE DISPOSAL SITE Elie/ <br />MANIFEST # —OR— OTHER <br />V <br />A <br />0 <br />VAPORS PURGED METHOD <br />L.E.L. READING AT REMOVAL (MUST <br />AMOUNT USED <br />0 <br />COMMENTS <br />TANK MATERIA (STEEL, FIBERGLASS, OTHER) TANK SIZE /el 11 7 /4,4 <br />TANK CONDITION (GOOD, (POOR), HOLES) LI/-roc./c-yl <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) -I # FEET r\ = <br />PIPING CONDITION (GOOD, POtfq;.HOLES) <br />DEPTH SOIL TYPE <br />hia <br />Cti <br />EXCAVATION SIZE: 1-,‘-)( X -7(". x / YDS OF SOIL: <br />OBSERVATION <br />13 / <br />,5 /LT- /c• A ,r) Cr' A..)(, 4 ico-Pr:ircn. <br />12'3 -?#t :Pre] <br />1*-7 ( <br />SAMPLE # <br />A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />-/\") ' /TN <br />TRENCH DIMENSION X X YDS OF SOIL <br />2 <br />DEPTH TO G. W. : *10,( rrt')ved FT SAMPLING METHOD <br /># OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />LABORATORY: 5 SAMPLERS NAME: <br />A <br />0 <br />CLOSURE IN PLACE MIXTURE: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />VOLUME: <br />/