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N <br />E <br />R <br />A <br />L <br />T <br />A <br />N <br />K <br />G <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />I <br />N <br />S <br />P <br />E <br />C <br />PHS-EHD - UNDEREWND TANK CLOSURE/ABANDONMW INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />�iYUiX//iY(/iY//NUM!/M!/X//,Y/LY/G4//M//YaYOY//uimuuuuu�.. <br />0 <br />OWNER NAME OWNER PHONE # <br />CONTRACTOR �I. 0 CON. PHONE# <br />SJLHD PERMIT ##i# EPA # <br />YIGY!/N!/.YOM!/.Yalui,✓aMvx/ivavvYVYVY//Y./�,/,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, __ FIRE FERMIT # <br />11V PLHUE __._._.._. T♦ 1��/�i�l����uLw�Y(f LJf� U///I////////.%////07//i/ <br />INSPECTOR �4+i+ DATE p <br />P -0I I0 TANK # 39 <br />R RINSED Y N) METH <br />I RINSE MOU "r <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED (Y/N) METHOD <br />A AMOUNT USED /00 <br />P L.E.L. READING AT REMOVAL (MUST B E0%) <br />0 n <br />R COMMENTS <br />C TANK MA'rERIAL (STEE FIBERGLASS, OTHER) <br />0 TANK CONDITION (GOOD, POOR, HOLES)r <br />N <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) o <br />DEPTH SOIL TYPE I OBSERVATION <br />T <br />A <br />N <br />K <br />S <br />JI EXCAVATION SIZE: <br />u <br />A DEPTH SOIL TYPE <br />M P <br />P I <br />L P <br />I E <br />N <br />k, u k� <br />X — X — <br />OBSERVATION <br />TANK SIZE (pj60Q <br />YDS OF SOIL: <br />T G TRENCH DIMENSION X X <br />I YDS OF SOIL <br />0 H DEPTH TO G. W. <br />N FT SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY:�J`0J. n /0 SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: l t <br />VOLUME: <br />EH 22043 (10/89) DRAW SITE MAP ON REVERSE <br />SAMPLE # <br />SAMPLE # <br />