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PHS-EHD - UNDERSkTANK CLOSURE/ABANDONM ,/VSPECTION <br /> (SHADED AREA TO S FILLED IN FOR THE FIRST�T$MK ONLY) <br /> IT <br /> d'f / Ai. , Cls T <br /> OWNER NAME r OWNER PHONE # <br /> N CONTRACTOR SGt� CON. PHONE# <br /> i E ` <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSRECTOR 4 DATE �Z p TANK # 39 <br /> R RINSED ) METHOD�L, RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> 1 <br /> V VAPORS PURGED 61-N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL eTEEL9 FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, FCgg HOLES) <br /> N <br /> A. S PIPE MATERIAL ST , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T ^ 10 ;p <br /> F At' 0&4 A40 -� r <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: ^L X 1 Z-1-1 X � YDS OF SOIL: <br /> S <br /> I ADEPTH SOIL TYPE OBSERVATION SAMPLE # <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 /> ! 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: /G!✓ ��DYr' <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />