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N <br /> PHS-END - UNDE .OUND TANK CLOSURE/ABANDON NT INSPECTION <br /> {SHADED AREA 10 BE FILLED IN FOR THE FIRbT TANK ONLY} <br /> 1 <br /> .f OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# , <br /> E r <br /> R 1 S,JLHD PERMIT # <br /> EPA # FIRE PERMIT # <br /> L .f ' r r rr�, flTt7� fr r <br /> INSPECTORL <br /> DATE `/2 ��i TANK # <br /> R RINSED I N} METHOD RINSE AMOUNT <br /> I p� <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED {Y! } METHOD,�� l� AMOUNT USED f� <br /> A <br /> P L. E. L. READING AT REMOVAL {MUST BE { 20%} <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL EE FIBERGLASS, OTHER} TANK SIZEf <br /> j K C 1 <br /> ! O TANK CONDITION {GOOD, P , HOLES} t Get r J` <br /> N <br /> TF'IF'E MATERIAL {STEEL, FIBERGLASS, OTHER}.1111.11,111.1111, , # FEE't'�jpf�tf /J <br /> � P I F'I NG CONI}I T I ON {GOOD, F'OOR, HOLES} �_._..-----' <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X II YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> SAMPLE # <br /> N M P <br /> S F' <br /> F' L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G, Wa : f� FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> t -------------------- <br /> O OTHER SAMPLE: <br /> LABORATORY: �)D lab 0(1 �5i1-r-) SA PLERS AME: <br /> n IrI <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> FH 23043 { I0l89} DRAW SITE MAP ON REVERSE, <br />