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PHS—EHD — UNDERGKI%OD TANK CLOSURE/ABANDONMEV. INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ar I m <br /> O <br /> OWNER NAME OWNER PHONE # L/ <br /> E <br /> N CONTRACT CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> 1 <br /> INSPECTORI',,51, DATE TANK # 39 - <br /> i <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> i S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED ( N METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS 416 <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> .~ S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH i SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A I) _ W <br /> I Niv k <br /> E K <br /> L <br /> D EXCAVATION SIZE: s X _ X _ YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G r TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: C XV �'� �_, SAMPLERS NAME[.L : <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />