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PHS—EHD — UNDERGFw.JND TANK CLOSURE/ABANDCNME. INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 2:2 <br /> wL%J///dJ//J <br /> b, HLCJU I'(t S Cv. U 1. 1 Y iC 1C/ <br /> I� OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR f CON. PHONE# <br /> E l <br /> R SJLHD PERMIT # EPA # // FIRE PE/RMITT',/ # <br /> LGu /G W H TEIf n IGQ GG%IGrG7/! <br /> — co rr <br /> INSPECTOR EpI DATE TANK # 39 — I — <br /> i <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> i <br /> ; <br /> V VAPORS PURGED ( AN . METHOD AMOUNT USED <br /> R liz <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 <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> P IS PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> T <br /> IPIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # i <br /> T i <br /> F A ! = c <br /> I N <br /> E K <br /> L <br /> D if EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <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 <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 12 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �� pi '�� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> i <br /> EH 2:04„ (10/89) DRAW SITE MAP ON REVERSE <br />