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PHS—EHD -- UNDER "JND TANK CLOSURE/AHANDONMEv " INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> IE.., <br /> OWNER NAME <br /> OWNER PHONE: # <br /> E <br /> N CONTRACTOR <br /> E �,� CON. PHONE#1 <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> INSPECTOR tea- 't39 <br /> 0 DATE a0 Cj} TANK # <br /> R RINSED YEN) METHODI RI SE AM N7 <br /> I <br /> N RINSATE DISPOSAL SITE ` <br /> S I <br /> E MANIFEST # —OR— OTHER _ <br /> V VAPORS PURGEDY/ ) METHODL AMOUNT USED <br /> A ° <br /> P L. E. L. READING AT REMOVAL <br /> O (MUST BEQ( <br /> T R COMMENTS il <br /> N TANK MATERIAL STEEL FIBERGLASS THER) <br /> K C TAN}: SIZE <br /> ` <br /> / O TANK CONDITION (GOOD, POOR, HOLES <br /> N )J _ /), <br /> u6ff�o r � h <br /> S PIPE MATERIAL ,(STEEL FIBERGLASS, OTHER) # FEE- <br />�. P T <br /> I PIPING CONDITION (GOOD;• POOR, HOLES) <br />' N t <br /> G DEPTH SOIL TYPE OBSERVATION C <br /> T SAMPLE # <br /> F A <br /> IN RC2, t <br /> E K Gv� <br /> L , <br /> 4 <br /> D EXCAVATION SIZE: X X <br /> S - YDS OF SOIL: <br /> I A DEPTH SOIL TYPE ' OBSERVATION <br /> k N M P h SAMPLE # <br /> S P I i <br /> P L <br /> P <br /> E I E <br /> C N <br /> T G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : <br /> N 2FT SAMPLING METHOD <br /> . <br /> G # OF HOURS SINCE DEWATERING: 4 _ <br /> f •� f �c <br /> 0 OTHER SAMPLE,:, r <br /> LABORATORY: jt,-7 J SAMPLERS NAME.- <br /> CLOSURE IN PLACE MIXTURE:' VOLUME: <br /> TH 23443 ( 10/89) DRAW SITE MAP ON REVERSE <br />