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PHS-EHD - UNDER® JND TANK CLOSURE/ABANDONN,,f INSPECTION <br /> (SHADED AREA TO—BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ,y OWNER NAME <br /> E OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EFA # <br /> A FIRE PERMIT # Z <br /> L <br /> INSPECTOR <br /> R RINSEDMETHOD <br /> I RINSE AMUUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST <br /> -OR- OTHER _ <br /> V VAPORS PURGED Y N) METHOD ,r ;_, <br /> A AMOUNT USED <br /> p L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> ° `f �occ <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TE <br /> K C . FIBERGLASS, OTHER) TANK SIZE / c`� / <br /> / 0 TANK CONDITION (GO <br /> N OOR HOLES) <br /> S F'IF'E MATERIRL (STEE FIBERGLASS, OTHER) it FEET <br /> P T ✓L� _� <br /> I PIPING CONDITION GOOD, POOR, HOLES) <br /> N -41ll U✓z2��d <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T Iolod��� SAMPLE # <br /> F A <br /> I <br /> N 11 F + D 4�c J e v-) <br /> E K w Gt QST <br /> L P <br /> D .�EXCAVATION SIZE: X / X i <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE it <br /> S P I p <br /> F' L P <br /> E I E <br /> 0 N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> 0 H DEPTH TO G. FT <br /> N SAMPLING ME' _ <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: / <br /> EH 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />