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PHS•-EHD -- UNDER&UND TANK CLOSURE/ABANDON JT INSPECTION <br /> (SHADED AREA 11*0 BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ,� <br /> 1 OWNER- NAME 1 r r OWNER PHONE # i <br /> E s <br /> N CONTRACTQR ' <br /> E Loo- o(j CON. PHONE# <br /> R SJLHD PERMIT # CAD `i4Z ' <br /> EPA <br /> # Z z FIRE PERMIT <br /> L � � ✓ 1 <br /> INSPECTOR ti/ �Ol DATE t �� 1 TANK # 39 <br /> R RINSED Y, N) METHOD T ���c4� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> V VAPORS PURGED (!�YN) METHOD �� � Ce AMOUNT USED <br /> L.-E. L. READING AT REMOVAL (MUST BE ( Cj%) i or <br /> 0 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS OTHER) TANK SIZE _ <br /> K C ' <br /> / 0 TANK CONDITION (13001), FLOOR) HOLES) <br /> N 1 on evident <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) #) FEETP T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F �- <br /> I N <br /> E K <br /> L 's ,,�� <br /> D EXCAVATION SIZE: X - X <br /> S ..1L_ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M PSAMPLE ## <br /> S P I <br /> P L <br /> E I E <br /> T G TRENCH DIMENSION <br /> X�_ Z�(p" X <br /> I ` YDS OF SOIL <br /> D H DEPTH TO FT SAMPLING I NC METHOD <br /> N <br /> Cl # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIX URE. <br /> N�A VOLUME: MIX <br /> EH 227043 ( 10/89) DRAW SITE MnP ON REVERSE <br />