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PHS-EHD - UNDERGV,,UND TANK CLOSURE/ABANDONM,"f INSPECTION <br /> (SHADED A�yRE,yA�r TO BE FILLED IyN�r FOR THE <br /> FIRST <br /> TANK ONLY) <br /> OWNER NAME OWNER PHONE # j <br /> E �a04) q� 8- � �a� y <br /> E CONTRACTOR �Q S ,y,_ j . CON. PHONE# <br /> R SJLHD PERMIT # EPAFA4)07 yo(o <br /> A 'i FIRE PERMIT # 13D� <br /> L <br /> INSPECTORT CIL DATE' a TANK # <br /> R RINSED (Y N) METHO <br /> I RINSE RMOUNT ti�00 aQ <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD <br /> A C;eAMOUNT USED S <br /> P L. E. L. READING AT REMOVAL (MUST B ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITIO ODD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ..STEEL FIBERGLASS, OTH ) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) r <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A W <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X X — YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <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 /> 0H DEPTH TO G. W. FT SAMPLING METHOD <br /> ----- <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />