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f n f <br /> PHS-EHD - UNDERAI JND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO° BE FILLED IN FOR THE .FIRST TANK ONLY) <br /> RJR" "7a <br /> E OWNER. NAME OWNER PHONE # <br /> E <br /> N ORTRA TOR CON. - PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # S' RE PERMIT # <br /> L <br /> INSPECT DATE// TANK :# 39 - 2-Y173 _ <br /> R RINSED Y N) METHOD RINSE AMOUNT. <br /> N RINSATE DISPOSAL SITE __F9G thl <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ( )N) METHOD j' AMOUNT USED <br /> A _L <br /> f, y�� <br /> P L. E. L. READING AT REMOVAL (MUST BE <br /> T R COMMENTS <br /> A <br /> N <br /> K C TANK MATERIAL STE FIBERGLASS, OTHER) TANK SIZE U <br /> d <br /> / O TANK CONDITION (GO , <br /> N POOR, HOLES) <br />{ <br /> S PIPE MATERIAL (STE , FIBERGLASS, OTHER) # FEET <br /> P T <br />} I PIPING CONDITION GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> f F A <br /> I N <br /> E K . <br /> L <br /> D EXCAVATION SI e <br /> ! S YDS OF SOIL: <br /> Y A <br /> 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 X <br /> I YDS, OF SOIL <br /> O H DEPTH TO G. W. ; FT SAMPLING METHOD <br /> N 2 <br /> G # OF HOURS SINCE DEWATERING; <br /> O OTHER SAMPLE: !. <br /> LABORATORY: <br /> SAMPLERS NAME: ` - <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />:.EH 23443 (14/89) DRAW SITE MAR ON REVERSE . <br /> ,: <br />