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PHS-EHD - UNDERG,�JND TANK CLOSURE/ABANDONM/Ei" , INSPECTION <br /> (SHADED AREA TO 'BE FILLED IN FOR THE FIRST TANK ONLY) : <br /> . <br /> E OWNER NAME I <br /> OWNER PHONE # <br /> N CONTRACTOR Sf <br /> E 1 CON. PHONE# <br /> R SJLHV PERMIT # <br /> EPA # <br /> FIRE PERMIT # <br /> L ' <br /> INSPECTOR-f DATE 1� TANK # 39_T <br /> i <br /> R RINSED Y N) METHOD RINSE AMO <br /> N RINSATE DISPOSAL SITE <br /> S ° t <br /> E MANIFEST # -OR- OTHER <br /> i V VAPORS PURGED (Y N) METHOD j <br /> A i AMOUNT USED , <br /> P L. E. L. READING AT REMOVAL (MUST RE <br /> a 3% Lrk_ o�- - 1a <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEELBERGLASS THER) TANK SIZE �Ca <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> x S P.1-PE MATERIAL .(STEEL, F.IAERGLASS, OTHER # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) 4 <br /> N i <br />' G DEPTH SOIL TYPE OBSERVATION <br /> T I SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L �v <br /> . D EXCAVATIO � " <br /> SIZE: _� X X � YI]5 OF SOIL: <br /> F <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> ,: <br /> S P I <br /> P L P <br /> E I E <br /> C N i <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SAIL <br /> © H DEPTH TO G. W. FT <br /> N SAMF'L I NG METHOD <br /> D # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: ka <br /> SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> H 23043 (10/89) DRAW SITE MAP ON REVERSE r <br />