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PHS-EHD - UNDERE UND TANK CLOSURE/ABANDONML,,.f INSPECTION <br /> (SHADED AREA TeBE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER NAME OWNER PHONE # R <br /> N ; CONTRACTOR CON. PHONE# <br /> E <br /> R , SJLHD PERMIT # EFA # FIRE PERMIT # <br /> L <br /> INSPECTOR }� DATE g � C TANK # <br /> R <br /> I RINSED tY N) METHOD-T i`VR RINSE AMOUNT S - <br /> N RINSATE DISPOSAL SI"fE 1 �9/� vlCk� <br /> S <br /> E MANIFEST # -OR- OTHER _ <br /> AV VAPORS PURGED (Y/N) METHOD -Dry 102 AMOUNT USED <br /> 3ocbs <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE 2ooD,--Ee- <br /> K C <br /> / 0 TANK CONDITION (GOOD, OOR, HOLES) S!ghi- CUs e� .eYld2nti-$ <br /> N <br /> S PIPE MATERIAL TEE , FIBERGLASS, OTHER) # FEETs' <br /> P T <br /> I PIPING CONDITI ODD , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A LO _ <br /> I N I Cl <br /> E K <br /> L <br /> D S EXCAVATION SIZE: 22- � 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 <br /> I X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 --- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: - <br /> LABORATORY: P n0 o1e SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />