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PHS-EHD - UNDERGMUND TANK CLOSURE/ABANDONMENT INSPECTION <br />(SHADED AREA ,yT�/ rO�, BEFILLED I,yN�,y FOR THE ,y <br />��irri� <br />�,yF IIS,yRSTTANK <br />�,y ONLY) <br />C; T E •�u G:Zi a b7u�'G,v1ay"Iii" lv�%!u a ri itG ON7u"7u"'7a"7>iYi1irilu"l.�r"`1v�7i77iri7l"i�i�ti7U a ii ri: <br />1 <br />E OWNER NAME F<�� OWNER PHONE # <br />E :CONTRACTOR ? CON. PHONE# <br />R SJLHD PERMIT # EPA # FIRE PERMIT # <br />L <br />INSPECTOR DATE TANK # "9 <br />R RINSED(Y/N) METHOD <br />I Ft I NSE AMO NT <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # _ _ -OR- OTHER <br />V VAPORS PURGED Y N) METHOD AMOUNT USED(� <br />A <br />F' L.E.L. READING AT REMOVAL (MUST B\( <br />T R COMMENTS <br />A <br />N TANK MATERIAL(STEE , FIBERGLASS, OTHER) TANK, SIZE 1/1'y <br />K7�{i <br />C 66 0 ,y <br />/ 0 TANK CONDITION ( GOOD OR,) HOLES) n k S �' /0' I e <br />S i b i u u-&_-a-- <br />S PIPE MATERIAL STEE , <br />FIBERGLASS, OTHER) # FEEf <br />P T <br />I PIPING CONDITION (GOOD, 'OO R HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE <br />, <br />F q <br />I N GSI- <br />E K <br />L <br />D <br />S EXCAVATION SIZE: I X L 2'X �- YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION <br />N M P SAMPLE # <br />S P I <br />P L F' <br />E I E <br />C N <br />T G TRENCH DIMENSION X X YDS OF SOIL <br />0 7_1 DEPTH TO G. W. : _- _ - FT SAMPLING METHOD <br />N <br />�► # OF HOURS SINCE DEWATEFRING: <br />0 OTHER SAMPLE.- <br />LABORATORY: <br />AMPLE:LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />`FF 2_10,43 (14')/89) , DRAW SITE MAP ON REVERSE <br />M° <br />