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ti <br /> PHS-EHD - UNDERC JND TANK CLOSURE / ABANDONM( i INSPECTION <br /> a ( SHADED AREA Tu BE FILLED IN FOR THE FIRST TANK ONLY ) <br /> � ,. OWNER NAME OWNER PHONE # <br />' E <br /> N ; CONTRACTOR CON . PHONE # <br /> E <br /> R SJLHD PERMIT # <br /> A FIRE PERMIT # / <br /> . r r � � r <br /> INSPECTOR co DATE � TANK # 39 <br /> I' <br /> R RINSED Y N ) METHOD <br /> I 5s c r RINSE AMOUNT 30 <br /> DtC� a <br /> N RINSATE DISPOSAL SITE / <br /> S <br /> E MANIFEST # -OR- OTHER <br /> qV VAPORS PURGED ( Y N ) METHOD y AMOUNT USED <br /> lim ( E' o /h 5 <br /> F' L . E.L . READING AT REMOVAL ( MUST RE < E <br /> 0 0% ) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( STEEL , FIBERGLASS , OTHER ) TANK SIZE <br /> K c S <br /> / 0 TANK CONDITION ( GOOD , POOR , HOLES ) <br /> N 7 Uelro� a � /� iku� P. <br /> S F' IF'E MATERIAL ( STEEL , FIBERGLASS , OTHER ) # FEET — V <br /> P T <br /> I PIPING CONDITION ( GOOD , POOR , HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> I <br /> N <br /> E K <br /> L <br /> 0 EXCAVATION SIZE : _ 5 X /0 X <br /> S b YDS OF SOIL : <br /> Y A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> P I <br /> (-' L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G . W . : FT <br /> N g SAMPLING METHOD <br /> - <br /> U # OF HOURS SINCE DEWATERING : <br /> 0 OTHER SAMPLE : <br /> LABORATORY : /! <br /> L CENON/ P SAMPLERS NAME : c �/P�,a <br /> CLOSURE IN PLACE MIXTURE : VOLUME : <br /> H 23043 ( 10 / 89 ) DRAW SITE MAP ON REVERSE <br />