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PHS—EHD — UNDERGR D TANK CLOSURE/ABANDONMEN�INSP TIiON <br /> 3 <br /> (SHADED AREA TO ME FILLED IN FOR THE FIRST 1ANK ONLY) <br /> E ;; OWNER AM G OWNER PHONE # <br /> N CONTRACTQR <br /> E <br /> ASJLHD PERMIT # E # aai2762 FIRE PERMIT # �/ <br /> L �3�9 <br /> INSPECTO DATE <br /> d <br /> R RINSEDN) METHOD��ZFple IZi�is e RINSE AMUUNT <br /> I 7S h <br /> N RINSATE DISPOSAL SITE 2F -f1 jeI 5 CAV) P <br /> S 3 <br /> E MANIFEST # —OR— 6THE§ <br /> V VAPORS PURGED (9/N) METHOD <br /> A �� AMUUNT USED f <br /> P L. E. L. READING AT REMOVAL (MUST BE ( Op;O 2 I <br /> O /D /o <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) Tf1NK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S F'IF'E MATERIAL STEE , FIBERGLASS, OTHER) # FEET / <br /> P T bl <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T �aFSC6 SAMPLE <br /> F A I`� wn . .tlo <br /> I N :2- <br /> c <br /> E K 4 v <br /> L <br /> D EXCAVATION SIZE: O L X /22 <br /> S L X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION vv <br /> N M P SAMP # <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. ; F T <br /> N SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME• jAr <br /> es YYV� <br /> CLOSURE IN PLACE MIXTURE ; <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />