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Y <br />PHS-EHD -- UNDERGOND TANK CLOSURE/ABANDONMA INSPECTION <br />(SHADED AREA TU BE FILLED IN FOR THE FIRST TANK ONLY) <br />It Lin mi <br />b <br />OWNER NAME s OWNER PHONE # <br />N CONTRACTOR CON. \ <br />E �Cil�'7 GCS PHONE# Lei 1J C - <br />R SJLHD PERMIT # EPA # C1 -C "IREE RM I T # I j t1 <br />L <br />f , I NSPECTOR S DATE (D �c r � TANK # 311) <br />�J R RINSED MN METHOD �s r INSE AMOUNT <br />I <br />N R I NSATE DISPOSAL S ITEr~? <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED/((Y/N).METHOD )> fL( AMOUNT USED 1 C rr-, <br />A <br />P L.E.L. READING AT REMOVAL ( MUST BE ( 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIALTEEL,% FIBERGLASS, OTHER) TANK SIZE���Q�t <br />K C <br />/ 0 TANK CONDITION (GOOD, 1OOR, HOLES) <br />N leI Cly ", <br />S WIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET 144 p1p(j?5 '-r�yy <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F <br />I N 777ri c -• [ <br />E K mac_ C'�- ,,. <br />L <br />DS EXCAVATION SIZE: ZI X� X YpS OF SOIL:aUs3 <br />I A DEPTK, SOIL TYPE OBSERVATION SAMPLE # <br />N M P <br />S P I <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X / -X YDS OF SOIL <br />I <br />0 H DEPTH TO G. W.: l_ �7 SAMPLING METHOD <br />N <br />G # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: Nj�- VOLUME: <br />EH 22043 (10/89) DRAW SITE MAP ON REVERSE <br />