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PHS–EHD – UNDERGRL__JD TANK CLOSURE/ABANDONMEN INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST , ANK ONLY) <br /> E OWNER NAME �Y OWNER PHONE # Z�r� <br /> 9/C--7- <br /> N CONTRACTOR CON. PHONE# ,/ ( <br /> R SJLHD PERMIT # EPR # ''' FIRE PERMIT # �*'/Z97/ <br /> L _ <br /> INSPECTOR Ldl DATEtj/? Cj TANN, # 9 – _��_ <br /> IRINSED / YES METHOD r �r /, ` RINSE AMUUNT <br /> N RINSATE D SPDSAL SITE c ! ✓` <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (V/A) METHOD D ( <br /> R t� AMOUNT USEDW <br /> P L. E. L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STE , FIBERGLASS, OTHER) TANK SIZE <br /> K C �Tf)j <br /> / 0 <br /> N TANK CONDITION (GOOD, 00 HOLES) (�jYrCGiQ,-) <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P � DiPi f1C� <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N T <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I G" <br /> N <br /> E K <br /> L <br /> D S EXCAVATION SIZE: 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 <br /> I --- — <br /> YDS OF SOIL <br /> 0 H DEPTH TO G. W. <br /> ---.--____.._ F 1 <br /> NSAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY : Me� Ze _ SAMPLERS NAME : - <br /> CLOSURE IN PLACE MIXTURE: <br /> I� I)� VOLUME: <br /> i- <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />