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PHS-EHD - UNDERQL ))ND TANK CLOSURE/ABANDONtM INSPECTION <br /> (SHADED AREA TLP%E FILLED IN FOR THE FIRS�ANK ONLY) <br /> J <br /> OWNER NAME <br /> E OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # <br /> A' FIRE PERMIT # <br /> L <br /> ll <br /> INSPECTOR DATE - <br /> TANK # 39 - <br /> R RINSED N) METHOD'�r <br /> I (�� RINSE AMOUNT zj_j{6 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- <br /> OTHER <br /> V VAPORS PURGED ) METHOD <br /> A �� AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL, FI RGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GO POOR HOLES) <br /> N <br /> S PIPE MATERIA STEL FI E <br /> P T SS, OTHER) # FEET �ae�-�i� <br /> I PIPING CONDITIO (GO <br /> N , POOR HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F q l` <br /> I N I � . <br /> E K " f <br /> Lt4j <br /> D �-�-EXCAVATION SIZE: ZLX X .� r <br /> S .� YDS OF SOIL: I <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <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:Cx20 4-n MPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: <br />_H 23043 (14/89) DRAW SITE MAP ON REVERSE <br />