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PHS-EHD - UNDER({'L���l!ND TANK CLOSURE/ABANDONM�' INSPECTION <br /> (SHADED AREA TUBE FILLED IN FOR THE FIRST"�ANK ONLY <br /> � . OWNER NAME <br /> E OWNER PHONE ## <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD ERMIT # EPA # <br /> A - FIRE PERMIT # <br /> L <br /> INSPECTOR DATE g' Z TANK # 39 <br /> R RINSED ( ) METHOD <br /> I �� <br /> l rnS� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> r9-r cam- tom--, <br /> E MANIFEST # <br /> T" -OR- OTHER <br /> V VAPORS PURGED Y/ ) METHOD <br /> A I cQ I AMOUNT USED S <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION ( POOR, HOLES) <br /> N <br /> • S PIPE MATERIAL (S EE FIBERGLASS, OTHER) # FEET c / <br /> P T <br /> I PIPING CONDITION (GOOD, GOR HOLES) <br /> N , <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE <br /> F A t.G'Ar <br /> I N ' <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S _`, X �� X � YDS OF SOIL: CSS <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 W <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT <br /> N SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY:G-rclo 4'n tGL.Lp SAMPLERS NAME: <br /> C/c- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />=H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />