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PHS—EHD — UNDERGRr' 'ND TANK CLOSURE/ABANDONME! INSPECTION <br /> (SHADED AREA TO.= FILLED IN FOR THE FIRST '."ANK ONLY) <br /> 9 <br /> EOWNER NAME OWNER PHONE # <br /> N sCONTRACTOR F <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # :� <br /> L <br /> INSPECTOR 441 DATE y�zz �z TANK # 39 <br /> R RINSED (Y N) METHOD PA' Sc((p <br /> wa5k RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE V <br /> S ` <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED (VN) METHOD <br /> A -Ce AMOUNT USEDtia X61 <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2UX,/� <br /> 0 (/ 96l L_ <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C P <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIALSTEEL FIBERGLASS, OTHER) # FEET <br /> P T �� <br /> N <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A % s.'f c <br /> I N /seo ✓w ^ /� <br /> E K <br /> L <br /> 0 EXCAVA ION SIZE: �y'' <br /> S � X _L= X YDS OF SOIL: tJSy�t �B <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I y e ofor rue sGo p„ <br /> P L P <br /> E I E <br /> ° -3 <br /> C N 6 s -Laxry, ee%r <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL z <br /> 0 H DEPTH TO G. W. : FT <br /> N SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING : <br /> 0 OTHER SAMPLE: <br /> LABORATORY: p5F SAMPLERS NAME: <br /> l � ��'8 •p'P�+AnI <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />