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PHS—EHD — UNDEROUND TANK CLOSURE/ABANDONINSPECTION <br /> (SHADED AREA TU BE FILLED IN FOR THE FIR#ANK/,y�/[/OONLY) <br /> �a"2 5 fir it i /1r r7 rr i rr /!ir/r r7i1 r f <br /> OWNER NAME J:G� OWNER PHONE <br /> E rG—r <br /> N CONTRACTQRr CON. PHONE# !� 33 <br /> E x'1304"c' (.)�G' <br /> R SJLHD/PERMIT # E A # FIRE PERMIT <br /> A <br /> L ti <br /> INSPECTOR �i- DATE /. TANK # 39 <br /> R RINSED /N) METHOD ' RINSE AMOUNT 5 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED CY/N) METHODU 4. AMGUNT USED -,,?5--/ <br /> A <br /> P L. E. L. READING FEZ REMOVAL (MUST- BE� ( �'— <br /> D <br /> T R COMMENTS ; L, alt f+�,✓ ,. , / �rA <br /> A <br /> N TANK MATERIAL ((STE , FIBERGLASS, OTHER) TANK, S I Z E/GC�Ga iG <br /> K C <br /> / 0 TANK CONDITION (GOOD, 'pOR�, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION JJ SAMPLE # <br /> F A f'�/ d%c G G7id/l G+"-C Gr/ CUIvZ Gt�i -�. - <br /> I +N /r 2 1 <br /> \ r <br /> E K <br /> L <br /> D EXCAVATION SIZE: XrX YDS OF SOIL: <br /> S <br /> I A DEPTH 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. : F'T SAMPLING METHOD <br /> N 2 <br /> El <br /> 0 # OF HOURS SINCE DEWATERING:OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME:L-1 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />