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PHS-EHD - UNDERIWUND TANK CLOSURE/ABANDONOT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> kfff-F. <br /> r <br /> E OWNER- NAME OWNER PHONE # <br /> .f <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A . ', r <br /> L <br /> INSPECTOR �<, F©!e, DATE TANK # .:,9 — Z �- <br /> R RINSED (Y& METHOD! RINSE AMOUNT— <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST #i 612.5y <br /> —OR— OTHER <br /> A VAPORS PURGED Y N) METHOD pfy C AMOUNT USED <br /> �.f s <br /> 0 L. E. L. READING AT REMOVAL (MUST BE < G;C) Q/p <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTEE , FIBERGLASS, OTHER) TANK SIZE <br /> / O TANK CONDITION (GOOD, POOR, HOLE Kc�-5 inj Top CCK-T-A+-KKK--w <br /> N <br /> �. S PIPE MATERIAL (STE , FIBERGLASS, OTHER) 74# FEET �-`— <br /> P T <br /> I PIPING CONDITION (GOOD, r'OO HOLES) <br /> N C'�r �oSio7— i ' <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A q ® <br /> I N 'r <br /> E K <br /> L1_ <br /> D EXCAVATION SIZE: <br /> S X X YDS OF SOIL: " �f�•(rz <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I ' - f n <br /> P L P <br /> E I E <br /> C N <br /> T G TR CH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> -� <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> ��In}n � <br /> CLOSUREIN PLACE MIXTURE: VOLUME: N[� <br /> EH 227043 ( 14/89) DRAW SITE MAP ON REVERSE <br />