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PHS-EHD - UNDER( )UND TANK CLOSURE/ABANDONPtieT INSPECTION <br /> (SHADED AREA TM BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 4rt7,M'7 <br /> OWNER NAME .r OWNER PHONE # <br /> E <br /> E , , CONTRACTOR "ollkfie ` / /� �/Q CON. PHONE# <br /> R SJLHD PERMIT # EPR # FIRE PERMIT # <br /> L I <br /> - J <br /> INSPECTOR DATE TANK # 39 - 106 <br /> I RINSED ) METHOD .rR1p&GE Al)►Sj� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITEE�viw20w�+i<i►tr�t� <br /> S <br /> E MANIFEST # -OR- OTHER <br /> VV VAPORS PURGED " N) METHOD D�� AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20;x) �S ` Oy'�$ <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( E , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION OOD 'OOR, HOLES) <br /> N <br /> S PIPE MATERIALTEE FIBERGLASS, OTHER) it FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A ca"t P i <br /> I N A criScoforerl-lon <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X 72' X _Z- 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 YDS OF SOIL <br /> -- — <br /> O H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> --- - <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME : <br /> FH 2-1043 ( 10/89) DRAW SITE MAP ON REVERSE <br />