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PHS-EHD - UNDERC 'UND TANK CLOSURE/ABANDONM r INSPECTION <br /> (SHADED AREA 1 BE FILLED IN FOR THE FIRS1 TANK ONLY) <br /> E ,rl OWNER- NAME CSC, OWNER PHONE <br /> N y CONTRACTOR SCj <br /> �GytCON. PHONE## X33,3 <br /> R SJLHD PERMIT # EPA <br /> A lr ' r FIRE PERMIT # <br /> / ; <br /> ( i <br /> J <br /> INSPECTOR i 64&`' DATE `�/�/'�/ TANK # <br /> R RINSED (Y/ METHOD <br /> I <br /> RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S rt y <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED f(Y%N) METHOD <br /> A AMOUNT USED <br /> L. E. L. READING AT REMOVAL (MUST BE ( EU%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> NC TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS <br /> P T , OTHER) # FEE"f <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N r. (ti✓ , . <br /> E K '; �- <br /> L 7. <br /> D EXCAVATION SIZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S F' I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOI L <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> �► # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br />----- VOLUME: <br />'H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />