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PHS-EHD - UNDER#UND TANK CLOSURE/ABANDONM* INSPECTION <br /> (SHADED AREA T BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME <br /> OWNER PHONE <br /> E 7 0 A <br /> y CONTRACTOR Se 1h C6Y CON. PHONE# 9 <br /> R SJLHD PERMIT # r�/o/ 'U ��52 <br /> A FIRE PERMIT # on NtSL - <br /> / 02 <br /> INSPECTOR . <br /> R RINSED /N) METHOD <br /> I j iC �n RINSE AMUUN" r JrS <br /> N RINSATE DISPOSAL SITE <br /> s e 'nei Sei ur'ces C 1'D Box i t <br /> E MANIFEST # rspt 5343 <br /> -OR- OTHER <br /> V VAPORS PURGED CY N) METHOD <br /> Fl Q/L �� — AMOUNT USED /Jn <br /> P L.E. L. READING AT REMOVAL 0 (MUST BE < 20%) wv <br /> T R COMMENTS <br /> A <br /> N TANK MA'fERIRL (STEE <br /> K C L FIBERGLASS, OTHER) TANK SIZE <br /> / O TANK CONDITION (GOOD, POOR HOLES) <br /> N <br /> S PIPE MATERIAL STEE , FIBERGLASS, OTHER) # FEET <br /> PTjU <br /> N <br /> I PIPING CONDITION (GOOD, . 00R HOLES) <br /> G DEPTH SOIL TYPEDBSERVATION <br /> T SAMPLE #N /S <br /> L <br /> D EXCAVATION SIZE: /1 X �0 <br /> S X /3 YDS OF SOIL: S� <br /> I R DEPTH SOIL TYPE OBSERVATION <br /> N M P I SAMPLE # <br /> S P I c n S i Or <br /> P LG <br /> E I E CUY <br /> C N <br /> T G TRENCH DIMENSION Iv' X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: eC�rrlTn� SAMPLERS NAME: , 9l7 ��tH <br /> CLOSURE IN GLACE MIXTURE: <br /> VULUPIE: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />