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PHS-EHD - UNDERGOND TANK CLOSURE/ABANDONMEO INSPECTION-L-G y �/ <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> IMAM <br /> E OWNER N �F_ 7 c/} F9S37i <br /> lle OWNER PHONE N <br /> /rS�b� b —�✓ O .� <br /> N CONTRACTOR <br /> E .r G�/s pf CON. PHONE# �Z <br /> R I'/ S.ILHD PERMIT N A1CDZ J <br /> A S�� � FIRE PERMIT <br /> INSPECT R TANK <br /> R RINSED '(Y N> METHOD <br /> Ile- 411,7Sa RINSE AMOUNT �r- <br /> N RINSATE DISPOSAL SITE - <br /> S c S-r2 viC eS <br /> E MANIFEST # -OR- OTHER <br /> V VAPORSPURGED Y ) <br /> A METHOD �,R �� I AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( EUX) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS OTHER) TANK SIZEfy <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) ✓ <br /> N <br /> S PIPE MATERIAL STEEL, FIBERGLASS, OTHER) 8 FEET <br /> T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) / <br /> N A 4 / 97l Ovt°i( 7Z /// OF <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE K <br /> F A a2 <br /> I N <br /> E K _ <br /> L <br /> D EXCAVATION SIZE: �1 <br /> S X X YDS OF SOIL: 7 5 S <br /> I A DEPTH SOIL TYPEOBSERVATION <br /> N M p SAMPLE 31 <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; Q <br /> N bi FT SAMPLING ME <br /> 0 # OF HOURS SINCE DEWATERING: <br /> W <br /> 0 OTHER SAMPLE: <br /> LABORATORY: /� <br /> lT � SAMPLERS NAME: A <br /> CLOSURE- IN PLACE MIXTURE: C <br /> VOLUME : <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />