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PHS--EHD -- UNDE6 'UND TANK CLOSURE/ABANDON'i.�T INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> irmlliflaffivFAT=,V ;w <br /> E OWNER- NAME S � OWNER PHONE # <br /> 7p o <br /> �N CONTRACTOR CON. PHONE# <br /> .E <br /> :R SJLHD PERMIT # EPA # FIRE .PERMIT # �` <br /> A <br /> L <br /> INSPECTOR r -d I DATE I/ J Q TANK # 39 <br /> I <br /> R ;RINSED ) METHO RINSE AMOUN�7�.�. <br /> I <br /> N �RINSATE DISPOSAL SITE - <br /> S <br /> E ;MANIFEST # -OR- OTHER <br /> V ;VAPORS PURGED ON) METHODs AMOUNT USED <br /> A , <br /> P ,L. E. L. READING AT REMOVAL (MUST r ( 20%) w/ <br /> 0 T <br /> T R -COMMENTS <br /> A <br /> N 'TANK MATERIAL TEE ., FIBERGL'ASS, OTHER) TANK SIZE <br /> K C 1� Qao <br /> Y 0, ;TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> Al <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> G T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A Tau f <br /> I N <br /> E j{ ►' i` � <br /> L <br /> D EXCAVATION SIZE: X X <br /> S YDS 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 YDS OF SOIL <br /> I <br /> 0 <br /> FH DEPTH TO G. W. : F7 SAMPLING METHOD <br /> # OF HOURS SINCE DEWATERING: <br /> © OTHER SAMPLE: <br /> LABORATORY: L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />