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PHS-EHD - UNDEK OUND TANK CLOSURE ABANDON N <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANKONLY) <br /> pi,OWNER- NAME (7 , <br /> J ❑WNE t PHONE # G>(�1 C�'- 17PO <br /> N CONTRACTOR J // <br /> E �T4GIL G! S ON. PHONE# <br /> R SJLHD PERMIT # EPA # <br /> A • ' FIRE PERMIT # 3 � <br /> L <br /> i <br /> INSPECTOR DATE TANK # 39 -. Uhf _ a �— <br /> R RINSED (Y N) METHODn <br /> I RINSE A OUNT <br /> N RINSATE DISPOSAL SITE <br /> S • <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGEDY N) METHOD <br /> A �; '4 AMOUNT USED�s�� <br /> P L.E.L. READING AT REMOVAL (MUST S� ( �GX) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEE FIBERGLASS, <br /> K C bTHER) TANK SIZE <br /> / 0 TANK CONDITION (GOOD POOR HOLES) <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, gTHER <br /> P T ;I <br /> # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATIO <br /> T SAMPLE # <br /> F A <br /> I N s <br /> E K <br /> L <br /> D EXCAVATION SIZE; LL X X <br /> S S OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E i E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO G. W. : FT <br /> N SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING.- <br /> 0 <br /> EWATERING:0 OTHER SAMPLE: <br /> LABORATORY: 1'- r �s rSAMPLERS NAME: ✓tZ-cit <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 22043 ( 10/89) DRAW SITE MAP ON RE <br /> FRSE <br />