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PHS-EHD - UNDEIND TANK CLOSURE/ABANDO FIRSTNK ONLY) <br /> INSPECTION I <br /> (SHADED AREA TU BE �yF�IILL,yL�ED IN FOR THEy�y �, Will <br /> r� �YUY�Xl1uYA Y/¢X!X! VY ' X�/ u aw briyiiYiriu �� .r <br /> wiuw uw .uwwwai w rNrw .a a w oA�D�� <br /> SOL <br /> OWNER NAME (f c Ter OWNER PHONE # X35 3s 9� <br /> E 4� is�r � <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # qy�y� FIRE PERMIIIT # <br /> L _ <br /> rj.}vck sa M Tr .s9 _ �SSd %_/• �;� <br /> INSPECTOR DATE TANK # r <br /> e _ 4 �_ <br /> R RINSED (Y/N) METHOD <br /> I E RMOUN- <br /> I �W <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -Oy ER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A - <br /> F' <br /> L. E. L. READING AT REMOVAL T ( 20%) <br /> o V <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEE7 F GLASS, OTHER) TANK. SIZE <br /> K C - <br /> / 0 TANK CONDITION (GOOD, DOR, HOLES) <br /> N _ <br /> z' S PIPE MATERIAL (STE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITIO (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE I OBSERVATION " <br /> T - <br /> F A <br /> I N r - <br /> E K - <br /> L �' <br /> D EXCR /TION SIZE: � X X Al2:-1v�-'/ YDS OF S L: <br /> S L <br /> I A DEPTH SOIL TYPE OBScRVATION M <br /> N M P <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 /> 0H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N c <br /> 0 # OF HOURS SINCE Nu: <br /> 0 OTHER SAMPLE• <br /> C SAMPLERS NAME: <br /> LABORATORY: <br /> CLOSURE IN PLACE I MIXTURE- VOLUME:: <br /> EH 23043 ( 10/89) DRAW __-- TOAP ON REVERSE <br />