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PHS—EHD -- UNDERr"QUND TANK CLOSURE/ABANDONf'y IT INSPECTION G �� <br /> (SHADED AREA BE FILLED IN FOR THE FIRSP"TANK ONLY) J <br /> . <br /> OWNER- NAME <br /> E JOtiOWNER PHONE <br /> i N CONTRACTOR <br /> E CON. PHONE# <br /> ,r a07- y yl <br /> R SJLHD RMIT # <br /> EP # <br /> EPA FIRE, PERMIT # <br /> L <br /> ii <br /> INSRECTOR DATE TANK # 39 — d , <br /> 1 — O/ <br /> R RINSED METHOD 1 <br /> NSE AMOUNT <br /> i N RINSATE DISPOSAL SITE <br /> Sas <br /> E MANIFEST # <br /> -OR- OTHER <br /> E <br /> V VAPORS PURGED (V/N) METHOD ' <br />' A AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST RE <br /> 0 <br /> li � �•� FSU <br /> T R COMMENTS <br /> A it <br /> N <br /> K C TANK MATERIAL.. STEEL FIBERGLASS, OTHER) TANK SIZE <br /> 0 TANK CONDITION (GOOD, OO R e HOLES) <br /> N i1 <br /> x. S PIPE MATERIAL ( TEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I II , <br /> PIPING CONDITION (GOO <br /> N D, POOR, HOLES) <br /> !1 <br /> E GDEPTH SOIL TYPE OBSERVATION <br /> F — IJ <br /> T I� SAMPLE # <br /> A s c�-�� <br /> I N /y <br /> E K �l i /E <br /> L i'I <br /> p <br /> EXCAVATION SIZE: �y X <br /> I A YDS OF SOIL: �0 <br /> DEPTH SOIL TYPE OBSERVATIO{�1� <br /> S P I a <br /> N M p / SAMPLE # <br /> i; � .� <br /> i <br /> P L R <br /> E I E i <br /> C N <br /> T G TRENCH DIMENSION/ <br /> I X X YDS OF SOIL <br /> D H DEPTH TO G. W. i -- <br /> N 2 - FT SAMPLING i] METHOD / <br /> �✓G SbPS <br /> O # OF HOURSS I NCE DEWATERING: 'i � <br /> �j <br /> O [ OTHFiE7;RSAMPLE: <br /> -- iq <br /> LABORATORY: _, �r <br /> SAMR LERS NAME: A <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />:H L;;043 (I0/89) DRAW SITE MAP ON REVERSE <br />