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PHS-EHD - UNDER OUND TANK CLOSURE/ABANDON, AT INSPECTION <br /> (SHADED AREA 1J BE FILLED IN FOR THE FIRST TANK ONLY) <br /> INTMU' ll 2j NO <br /> s f <br /> a OWNER NAMEOWNER PHONE # <br /> f <br /> N CONTRACTOR (/J CON. PHONE# <br /> E <br /> R f SJLHD PERMIT # EPA # FIRE PERMIT <br /> A <br /> INSPECTOR �,/. DATEZ-2 ' q } TANK # .,9 - - } <br /> R R I LASED 6F/N) METHOD j�-i&— �r r-� � F I NSE AMOUNT =� ci�- >� <br /> I tr- X0,2 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N} METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE { 20%) <br /> 0 <br /> T R COMMENTS <br />� A <br /> N TANK MATERIA (ST EE , FIBERGLASS, OTHER} TANK SIZEL'.- fit <br /> K C <br /> l 0 TANK CONDITION (GO O HOLES) <br /> N <br /> A S PIPE MATERIAL STE FIBERGLASS, OTHER} # FEET <br /> P 7 <br /> I PIPING CONDITION (GOOD, POOR, HOLES) c(QC. <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A o2wt' CJ <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I I A DEPTH OIL TYPE OBSERVATION SAMPLE # <br /> N M P <br />? S P I r t1Crl c?, <br /> P L P 1 r� LL <br /> E I E <br /> E C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O HUDEHG4 W. : nprr ca,rnf i FT SAMPLING METHOD <br /> N <br /> 0 S SINCE DEWATERING: <br /> 0 PLE:LA --- `�` SAMPLERS NAME:f-----JLr -- <br /> CLOSURE IN PLACE MIXTURE: _-- VOLUME: <br /> :,. ,# 2-3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />