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I� <br /> PHS -EHD - UNDEf JUND TANK CLOSURE/ABANDON, , T INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRS—T TANK ONLY) <br /> StAl <br /> 1 <br /> # OWNER NAME OWNER PHONE # 1 <br /> E <br /> N CONTRACTOR CON. PHONE# r, <br /> R f SJLHD PERMIT # EPA # FIRE PERMIT # r <br /> t 'f t ltl�.;jt <br /> A f l t ! <br /> (1GL <br />' If <br /> L ,� ` <br /> INSPECTOR - DATE Zf��� TANK # *,9 <br /> R RINSED { l N) METHOD RINSE AMOUNT <br /> i I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED IN} METHOD -4q AMOUNT USED <br /> A <br /> �bS <br /> P L. E. L. READING AT REMOVAL {MUST BE { vG; ) <br /> O <br /> T R COMMENT'S <br /> A <br /> NTANK MATERIAL TEE , FIBERGLASS, OTHER} TANK SIZE -20/0470 <br /> 1 O TANK CONDITION {GOOD, POOR HOLES) <br /> N <br /> S PIPE MATERIAL (STE , FIBERGLASS, OTHER) # FEE'( <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br />! <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A DEPTH OIL TYPE OBSERVATION SAMPLE. <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> o O H DEPTH TO Ga W. FT SAMPLING METHOD ---- <br /> N E <br /> Ct # OF HOURS SINCE DEWATERING: <br /> [O][__6THER SAMPLE: <br /> LABORATORY: = SAMPLERS NAME: <br /> f <br /> CLOSURE IN PLACE MIXTURE: -- VOLUME: <br /> EH 2_C 43 { 10/89} DRAW SITE MAP ON REVERSE <br />