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V <br />A <br />0 <br />0 <br />PHS-EHD - UNDEI JUND TANK CLOSURE/ ABANDONI.....,INIT INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />I . <br />weigwitemrar ast TaggfrepinElliff !firm <br />OWNER NAME OWNER PHONE # <br />N 5 CONTRACTOR CON. PHONE# <br />SJLHD PERMIT # <br />EPA it <br />e/1/11"//q/ 9/%12,/ ?Me / / I/ / / <br />FIRE PERMIT # <br /> <br />INSPECTOR,(-/, DATE <br /> <br />RINSED (<90 <br />METHOD v <br />RINSATE DISPOSAL SITE <br />-OR- OTHER <br />AMOUNT USED <br />L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br />( C L <br />COMMENTS <br />MANIFEST it <br />VAPORS PURGED ((Y//N) 1 METHOD r <br />I/2/5'0 I TANK it 29 - /Z7- -cc <br /> <br />RINSE AMOUNT / <br />PIPING CONDITION (GOOD, POOR,/ HOLES) ^ - <br />LAL <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I it FEET 5 <br />',, - t <br />TANK MATERIAL (E FIBERGLASS, OTHER) TANK SIZE 40er <br />/-7 , <br />).)r)-i- • TANK CONDITION (GOOD, CPOOR (I, HOLES) <br />C (,(73 - V1(0 t <br />A <br />ri <br /># OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />DEPTH <br />13' <br />rzcc /-7 <br />EXCAVATION SIZE: .54 X/ YDS OF SOIL: <br />DEPTH <br />/3 /4 " <br />/SOIL <br />SOIL TYPE <br />Si <br />OBSERVATION <br />OBSERVATION <br />/ti') (1-/Cr; AL-1 <br />h ; <br />)Ty,e N <br />"'A( <br />SAMPLE # <br />SAMPLE # <br />TRENCH DIMENSION X X 1 YDS OF SOIL <br />DEPTH TO G.W.: 64)1g--rr FT 1 SAMPLING METHOD -- <br />LABORATORY:??Lc <br />J <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />1fl"" UNE : <br />EH 22043 (10/B9) <br />LAAW SITE MAP ON REVERSE <br />A <br />0