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PHS-EHD - UNDERP" ND TANK CLOSURE/ABANDON <br /> INSPECTION <br /> (SHADED AREA 1 1 E FILLED IN FOR THE FIR$T.,:,,ANK ONLY) <br /> E <br /> OWNERNAME OWNER- PHONE # ' <br /> .s <br /> N CONTRACTOR <br /> E CON. F�HONE#; <br /> {' <br /> R i SJLHD PERMIT # } <br /> A . ' EPA # . FIRE PERMIT # <br /> L <br /> INSPECTOR <br /> [; Pu„-f- DA1"E J 1 TANK # <br /> R RINSED (Y N) ; METHOD � ' � <br /> I '` `�`:Surrs RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S iNP r <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD <br /> A �j` rcr AMOUNT USED �0 1b'' <br /> P L. E. L. READING AT REMOVAL (MUST DE ( 2G%). <br /> Ol <br /> T R COMMENTS <br /> A <br /> N <br /> TANK MATERIAL <br /> K TEEL, FIBERGLASS, OTHER) TANK SIZE <br /> 000 G <br /> / O TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> A' S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITIONODD POOR, HOLES)- <br /> N <br /> G DEPTH SOIL TYPE.: OBSERVATION ' <br /> T SAMPLE # <br /> A j <br /> ry <br /> E K <br /> L <br /> D EXCAVATION SIZE: -L,7- X X 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 yy <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL 1 <br /> r <br /> O H DEPTH TO G. W, : FT SAMPLING ME"f HDD <br /> N - —� <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> L. <br /> CLOSURE IN PLACE MIXTURE: VDLUhlE: -- <br /> EH :3053 ( 10/89) DRAW SITE MAP ON REVERSE <br />