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PHS—EHD — UNDERG:z-.JUND TANK CLOSURE/ABANDONMOI T INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />E OWNER NAME� OWNER PHONE # dao y 3 7 � <br />N CONTRACTOR CON. PHONE# <br />R SJLHD 'ERMIT # EPA # <br />A , FIRE PERMIT # <br />✓lC- lu�.'�v SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE : VOI__UhiL <br />EH 3olk3 (1c)/89) DRAW SITE MAF' ON REVERSE <br />INSPECTOR 7 <br />DATE�'jlC) DC7 <br />TANK it 39 <br />R <br />RINSED <br />RINSE <br />4 MOU T <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # —OR— OTHER <br />V <br />VAPORS PURGED kv/N) <br />METH <br />AMOUNT USED <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST RE <CiX) <br />T <br />R <br />COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />0 <br />/ <br />0 <br />TANK CONDITION ( GOOD, QZOOR HOLES) P �� r—� <br />N <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />P <br />T <br />I <br />NAu <br />PIPING CONDITION (GOOD, OORj HOLES) <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />T <br />SAMPLE I# <br />F <br />q <br />I <br />N <br />y — — <br />E <br />K <br />— <br />nj <br />L <br />D <br />S <br />EXCAVATION SIZE: X X <br />_.___ ,_. <br />YDS Of- SOIL: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />N <br />M <br />P <br />SAME LE 44 <br />S <br />P <br />I <br />F' <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X YDS OF= SUII_ <br />0 <br />N <br />H <br />DEPTH TO G. W. : F T <br />-.-.... --- — - SAMPLING METHOD <br />C) <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY <br />✓lC- lu�.'�v SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE : VOI__UhiL <br />EH 3olk3 (1c)/89) DRAW SITE MAF' ON REVERSE <br />