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PHS-EHD - UNDERG&ND <br />(SHADED AREA TO BE <br />TANK CLOSURE/ABANDONM* INSPECTION <br />FILLED IN FOR THE FIRST TANK ONLY) <br />.... <br />- ............. <br />�Yul/r�ii r�%b7fiibi r r r <br />lir!�ni a fir r 'CF�7""r'�irr%ir,r%Irri ' <br />OWNER NAME <br />OWNER PHONE # <br />E <br />N CONTRACTOR <br />CON. PHONE# <br />E <br />R SJLHD PERMIT # EPA # <br />FIRE PERMIT # <br />R 'I <br />11110 1 <br />Ml <br />r <br />L -- <br />INSPECTOR I -F k <br />DATE <br />TANK # <br />R <br />RINSED (YCN)) METHOD RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (Y N) <br />METHOD J4 <br />AMOUNT USE D <br />A <br />P <br />i <br />L.E.L. READING AT REMOVAL (MUST Iii ( 20%) <br />T <br />0 <br />R <br />COMMENTS <br />A <br />v <br />N <br />TANK MATERIALSTEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />5j <br />C <br />�1�- <br />K <br />/ <br />O <br />N <br />TANK CONDITION (GOOD, POOR, HOLES) r S CG 5 2J <br />S <br />F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />I <br />A <br />N� <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X X <br />-- — <br />YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />T- <br />P <br />L <br />F' <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL_ <br />0 <br />H <br />DEPTH TO G. W. FT <br />SAMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE: <br />HFLABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />