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-OR- OTHER <br />AMOUNT USED - <br />/ K.1) <br /> <br />BE ( 20%) <br />LZ- <br />PHS-EHD - UNDEF JUND TANK CLOSURE/ABANDON, AT INSPECTION <br />(SHADED AREA 1U BE FILLED fe IN FOR THE FIRST TANK ONLY) w mum WM! - _ _ <br />/-7 <br />OWNER NAME <br />CONTRACTOR -- <br />OWNER PHONE # z <br />CON. PHONE# ) <br />SJLHD PERMIT # <br />FIRE PERMIT 44 /e;it• (///le 7 dr>1 Al A/ / ArOWAPI(/' /// pli9/// <br />(":%; LtCe EPA # <br />e <br />INSPECTOR DATE ///z150 TANK # :39 - <br />I <br />METHOD j RINSE AMOUNT )7--- <br />J <br />RINSATE DISPOSAL SITE <br />RINSED (Y/N) <br />V <br />A <br />0 <br />MANIFEST # <br />VAPORS PURGED METHOD <br />L.E.L. READING AT REMOVAL (MUST <br />COMMENTS <br />••••••.1411.1,1 <br />A <br />PIPE MATERIAL 4-1-Eg.1.4 FIBERGLASS, OTHER) I # FEET <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />TANK MATERIAL (S'TEELy FIBERGLASS, OTHER) 1 TANK SIZE <br />TANK CONDITION (GOOD,(1OOR., HOLES) tt-''7/C7)1 <br />• <br />DEPTH <br />---77'/ <br />SOIL TYPE <br />3 <br />OBSERVATION <br />_t (7- cs-/ nt_ •-e>V7(16-1-/L-7-- <br />it 3 A./C <br />(Stimr <br />SAMPLE # <br />Nc..1 <br />EXCAVATION SIZE: <br /> <br />,Lx YDS OF SOIL: <br /> <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />4-1 . <br />TRENCH DIMENSION --X -- X <br />1 <br /> YDS OF SOIL <br /> <br />DEPTH TO G. W. : e=r)LcL71-ci FT 1 SAMPLING METHOD — <br />oc-r <br /># OF HOURS SINCE DEWATERING: <br />0 <br />A <br />of OTHER SAMPLE: <br />LABORATORY: <br />A <br />0 <br />SAMPLERS NAME: <br />CLOSURE IN PLACE _ , vnLumL: <br />EH 22043 (10/89) <br />MIXTURE: /,/ <br />-RAW SITE MAP ON REVERSE