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PHS-EHD - UNDERGONND TANK CLOSURE/ABANDONMERr INSPECTION <br /> (SHADED AREA <br /> T�OBE FILLED IN FOR THE FIRST TANK /ONLY) <br /> E OWNER NAME q OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> i <br /> R SJLHD RMIT # EPA °�4'3}/ FIRE PERMIT # <br /> A - !3 1 3oZ <br /> L / e <br /> INSPECTOR DATE1[ TANK # 39 <br /> R RINSED G/N) METHOD <br /> I �rr�/e >�ecrM RINSE AMOUNT <br /> N RINSATE DISPDSAL SITE <br /> S• H �/f <br /> E MANIFEST # -OR- OTHER <br /> A VAPORS PURGED l�N) METHOD o- /�� AMOUNT USED <br /> BL <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK. SIZE <br /> K C 5cC7ocC4 <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET /pCjrfalc� <br /> P T <br /> I PIPING CONDITION (GOOD, POOR,) HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> 3 � <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: .fir X i / j <br /> S 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 3 <br /> I — -- /U o <br /> 0 H DEPTH TO G. W. : FT <br /> N 2 SAMPLING METHOD <br /> —---- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: 1�«/'r eu lean f'r c /iicL � .. <br /> I _ SL SAMPLERS NAME: ��� 0/0 <br /> CLOSURE IN PLACE MIXTURE: ` <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />