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- - PHS-EBD - UNDERGIND TANK CLOSURE/ASANDONM INSPECT"ION <br /> (SHADED AREA TO '-BE FILLED IN FOR THE FIRST TANK ONLY) 1 <br /> R <br /> 1, <br /> OWNER NAME <br /> E 6. F. (� OWNER PHONE # p— a <br /> N CONTRACTOR - CON.. PHONE# <br /> E 1 <br /> R SJLHD PERMIT # EPA # FIRE PERMIT <br /> L <br /> INSPECTOR DATE TANK # �9 -- _ � <br /> R RINSED UF/N) METHOD RINS 'A <br /> M_O NT <br /> I <br /> N RINSATE DISPOSAL SITE ki <br /> S <br /> E MANIFEST # -DR- OTHER <br /> V' VAPORS PURGED Y N) TMETHOD AMOUNT USED A � l <br /> P L. E. L. READING AT REMOVAL (MUST B < 2Cjti) <br /> 0 cc.y GL <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE j.l Q <br /> K C <br /> / O TANK CONDITION (GOOD OR HOLES) r'� s. 1o' e <br /> N ' 11�t U'-I S I b te <br /> x S PIPE MATERIAL STEE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, 100R HOLES) <br /> N _ '' "~- i <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> ti <br /> F A -- — -- GS — . <br /> I N i <br /> E K <br /> f._ <br /> L <br /> D EXCAVATION SIZE: X � �yYX <br /> S 1.�. YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M p <br /> S P. I ' <br /> P L P I <br /> E I E 1 <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS Of= SOIL <br /> ---- - <br /> © H DEPTH TO G. W. : . __________ — FT SAMPLING METHOD <br /> N .; <br /> U # OF HOURS SINCE DEWATERING: - <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: ' VOLUME: <br />�H 23443 ( 10/89) lip, DRAW SITE' MAP ON REVERSE <br /> M� <br />