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FIRE PERMIT # <br />OBSERVATION <br />OBSERVATION <br />PHS-EHD - UNDEP JUND TANK CLOSURE/ABANDON 4T INSPECTION (SHADED AREA BE FILLED IN FOR THE FIRS! TANK ONLY) 4cfcrigfr 121225MairallrETAINIFITEISMISZEIV112, <br />OWNER • NAME OWNER PHONE # <br />CONTRACTOR CON. PHONE# <br />SJLHD PERMIT It EPA # e //17// it 4// <br />INSPECTORK. DATE 0/2/5c TANK # 39 — <br />RINSED (Y/N <br /> I METHOD RINSE AMOUNT (;-C, / <br />1 - :3 <br />A <br />RINSATE DISPOSAL SITE <br />V <br />0 <br />MANIFEST # <br />I AMOUNT USED /:)) <br />L. E. L. READING AT REMOVAL (MUST BE ( 20%) 5:5 / LEL_ <br />VAPORS PURGED ((l/1//N) METHODA,i9 <br />-OR- OTHER <br />0 <br />1 <br />COMMENTS <br />TANK MATERIAL TEE.J.„), FIBERGLASS, OTHER) I TANK SIZE 52(-77.9 <br />TANK CONDITION (GOOD1 D0R2 HOLES) <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />PIPE MATERIAL tSTEEL, FIBERGLASS, OTHER) # FEET 216 /Li <br />Ll( ,11C/5-)1 <br /> A:- 5 <br />fr---) • • <br />It <br />SAMPLE It <br />tt '2- ( ee,o) <br />EXCAVATION SIZE: X X 777' j YDS OF SOIL: / <br />DEPTH SOIL TYPE <br />DEPTH SOIL TYPE SAMPLE # <br />// <br />TRENCH/DIMENSION X X YDS OF SOIL <br />DEPTH TO G.W.: ILLz2tLa)FT SAMPLING METHOD <br />z <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: 17? 5 <br />CLOSURE IN PLACE MIXTURE: <br />I SAMPLERS NAME: .1,,,,-- bi—,(c-n_kr <br />VOLUME: <br />0 <br />EH 23043 (10/89) bqW SITE MAP ON REVERSE