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PHS-EHD - UNDEROUND TANK CLOSURE/ABANDONIOT INSPECTION <br /> (SHADED AREA lU BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �fC"� ti ,i /':�,� >; �/-�.. �,, �` /�.''3�.�.-✓_firz/lC /l Siii cLE Lz z'i <br /> � OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> R �f SJLHD PERMIT # €PA # , <br /> AFIRE PERMIT # ��/U� �3 <br /> / r r r r r kq[[/ j�tiP/G/�.. S,f✓O <br /> L <br /> J <br /> INSPECTOR , �� DATE TANK # 39 - >O c 0 _ - � - <br /> R RINSED (Y/L4Jy METHOD - RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED 6/N) METHOD ✓' AMUUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 2UX) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MA*fERIAL.i(STEEL, ' FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, COOR} HOLES) <br /> N _ <br /> S F'IF'E MATERIAL (STEEL, ERGLASS, OTHER) # FEET <br /> G T <br /> I PIPING CONDITIO GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F q n ��i ocl �,,rr/ /rs<✓l,aFr,,n — s <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 2 ' X <br /> S 5 YDS OF SOIL: a�yr/J <br /> I A DEG OIL TYPE OBSERVATION <br /> N M SAMPLE # <br /> S P " r <br /> F' Ln <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL 1 <br /> I <br /> 0 H DEPTH TO G. W. FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME : / <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />