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PHS--EHD - UNDERGRt,�,D TANK CLOSURE/ABANDONMEf '` INSPECTION 0 <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> roo(,tA C, Ay <br /> C inl.4 <br /> I pA n OWNER PHONE # <br /> E , OWNER- NAME t r a �� T� <br /> N , , CONTRACTOR l c CON. PHONE# <br /> 9- y�z-LI.s�f/ <br /> R SJLHD PERMIT #,t-A,, DO�ZzS� -EPA # FIRE PERMIT # <br /> I T DATE 39 - �_ _ <br /> R RINSED Y N) METHOD <br /> I RINSE AMOUNT -� � <br /> N R I NSATE DISPOSAL SITE ir�-,�, Stz, (/jC�S' <br /> S <br /> � ��yc <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHODpgy <br /> A ,e - AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST B ( EQx) <br /> 0 <br /> T R CDMMENTS � <br /> A <br /> N <br /> K C TANK MATERIAL ST�E , FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> PIPE MATERIAL STEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITID <br /> N (GOOD; ODR, HOLES) <br /> G DEPT SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> E N <br /> K <br /> L <br /> D EX �jA X X <br /> YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL Ty P OBSERVATION ��rl <br /> N M P , SAMPLE # <br /> S P <br /> P 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 - SAMPLING METHOD �' <br /> N 2 4T7,L � D/ , <br /> Q # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> T LABORATORY: SAMPLERS NAME: <br /> /2U <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: ' <br /> 23043 (I0/89) DRAW SITE MAP ON REVERSE <br />