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PHS-EHD - UNDERr*JND TANK CLOSURE/ABANDONM*- INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />LIi6 <br />T�jifiirYT101, r r�rY)'7p�r�u`firl)/lii <br />llSlr} f", .0 tl't <br />OWNER NAME u7 <br />OWNER PHONE # <br />E <br />N <br />E <br />CONTRACTOR �L O <br />CON. PHONE# <br />R <br />SJLHD PERMIT # EPA # FIRE PERMIT # /, e <br />A <br />L <br />r <br />INSPECTOR (d� <br />DATE ) 3a S�� <br />TANK # 39 <br />R <br />I <br />�D <br />RINSED �r//N) METHOD RINSE AM UNTLl <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y N) <br />METHOD <br />AMOUNT USED <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />/ <br />0 <br />N <br />TANK CONDITION (GOOD, F'0 HOLES)��� S fhb oB <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHE # FEET <br />P <br />T <br />I <br />N <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A7 <br />I <br />N <br />.� S bacL' i <br />E <br />K <br />t <br />L <br />D <br />EXCAVATION SIZE:IAF X X �_. <br />YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL. TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />-- --- <br />YDS OF SOIL <br />I-- <br />0 <br />FI <br />DEPTH TO G. W. FT <br />SAMPLING METHOD <br />i� <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE: <br />HiLABORATORY: <br />Cd � <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />