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PHS—EHD — UNDERG,,,�ND TANK, CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO RE yFILLED I,yN�/y FOR THE <br /> v ' r� ri�ir v ilii FIIRSTTAANNKONLY) <br /> �M�11TR1 <br /> M67/1 <br /> /6 / 'r ii r i <br /> E OWNER NAME OWNER PHONE # <br /> E a <br /> CONTRACTOR 1 O f CON. PHONE# � a� <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR�I�S DATE l g �� TANK # a9 — 13.yZ <br /> R RINSED -A/N) METHO /l , RINSE AMGUNT5S <br /> N RINSATE DISPOSAL SITE D <br /> 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 li4 ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, OTHER7 TANK SIZE �rOD <br /> K C <br /> / O TANK CONDITION (GOOD, POO R HOLES) 1feJ �z <br /> N A be kA <br /> j S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, X00 HOLES) <br /> N <br /> G T DEPTH SOIL TYPE _OBSERVATION SAMPLE # <br /> F A <br /> I N <br /> EK <br /> L <br /> S <br /> D EXCAVATION SIZE: lX X � r YDS OF SOIL: <br /> S <br /> I A DEPTH 1 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 TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 7 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> J 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> Lo. <br /> OTHER SAMPLE: <br /> LABORATORY: G. L SAMPLERS NAME: <br /> JF­CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 3043 (10/89) DRAW SITE MAP ON REVERSE <br />