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PHS-EHD - UNDER qND TANK CLOSURE/ABANDONI i INSPECTION <br /> (SHADED AREA TU E FILLED IN FOR THE FIRST TANK ONLY) <br /> ,/ OWNER NAME AWNER PHONE # <br /> N CONTRACTOR CON. PHONE# / <br /> R SJLHD PERMIT # €PA #, FIRE PERMIT # 3 G <br /> L <br /> r <br /> INSPECTOR • G DATE TANK # 39 - 5'OCU - aA <br /> )L <br /> R RINSED (Y/CN� METHOD RINSE AMOUNT <br /> �- <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED LV/N) METHOD <br /> A AMOUNT USED <br /> rz(E' <br /> 0 L. E. L. READING AT REMOVAL (MUST BE ( 20;:) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL�STEEL, ' FIBERGLASS, OTHER) TANK SIZE <br /> K C _ _ 3rG,G�, r <br /> / 0 TANK CONDITION (GOOD, - 'O R <br /> N HOLES) <br /> S F'IF'E MATERIAL (STEEL, ERGLASS, OTHER) # FEET <br /> P T !� <br /> I PIPING CONDITIO GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> c��/'? Gz:rd S.�✓�rva-iron <br /> I N <br /> E K <br /> L <br /> D :EXCAVATION SIZEc� X 7 r X <br /> S . 3 _ YDS OF SOIL: yd -3 <br /> I A DEG OIL TYPE OBSERVATION <br /> N M �y SAMPLE # <br /> S P ------ <br /> P <br /> -G L ✓ ? r <br /> n <br /> E I E 0 " G <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0H DEPTH TO G. W. <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ) SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> H 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />