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i <br /> PHS-EHD - UNDERG „ ND TANK CLOSURE/ABANDONME4T INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER NAME OWNER PHONE <br /> # <br /> E <br /> N CONTRACTOR <br /> E CON. PHONE# / <br /> R SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # Q a G <br /> J <br /> INSPECTOR a� DAT- h / <br /> 02 l7 IV TANK # <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A AMOUNT USED <br /> F-' L. E. L. READING AT REMOVAL (MUST BE ( SOX) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) <br /> K C TANK SIZE i <br /> / 0 TANK CONDITION O POOR, HOLES)), <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OT R) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K t l ►, F � tt <br /> L <br /> D SIZE:EXCAVATION SE: X X / <br /> S � YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE 41 <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 /> O H DEPTH TO G. W. : <br /> N ___, F=T SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> 'L. SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />