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PHS–EHD – UND a^ROUND TANK CLOSURE/ABAND NT INSPECTION <br /> (SHADED ARE 0 BE FILLED IN FOR THE FI TANK ONLY) <br /> 0 roc k-�N <br /> ``,� , WNER NAME OWNER PHONE # <br /> N , CONTRACTOR CON. PHONE# <br /> E GIS�r <br /> R SJLHD PERMIT # '4`=(x'r3 ' <br /> A . ' EF'A # '76 'i FIRE PERMIT # <br /> L <br /> INSPECTORu�f DATEy/7 TANK # 39 <br /> R RINSED (Y ) METHOD <br /> I I A � Y` RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # J � 6 –OR– OTHER <br /> -------------------- <br /> V I VAPORS PURGED ON) METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> NCTANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE <br /> K <br /> / 0 TANK CONDITION GOO POOR, HOLES) <br /> N <br /> j S PIPE MATERIALSTEEL FIBERGLASS, OTHER) # /' <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T P` SAMPLE # <br /> I A �, n `-'' ! / n'i°a'� r rA_' d�c cr•a Y•ens } <br /> N <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S -- X q` X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M I P SAMPLE # <br /> S P I <br /> P L P <br /> E I F- <br /> c C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> i <br /> O H DEPTH 70 G. W. : FT <br /> N SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �!� y o SAMPLERS NAME: <br /> u �` ,., <br /> Lc—LOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />