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PHS-EHD - UNDER JND TANK CLOSURE/ABANDONfv*,..,.i1' INSPECTION <br /> (SHADED AREA TG BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �(.. GC �f vi �D P�YtCGw limp <br /> OWNER NAME <br /> E <br /> OWNER PHONE # <br /> NCONTRACTOR D 1 CON. PHONE# <br /> E Caot / �Oa- Jr�' <br /> R SJLHD PERMIT # EPA # <br /> A . FIRE PERMIT # <br /> L i <br /> INSPECTOR Tisa DATE # <br /> R RINSED ( /N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED aVN) 7m- <br /> P <br /> ETHOD AMOUNT USED <br /> A <br /> L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 U-1�C2�rU <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL STE , FIBERGLASS, OTHER) TANK SIZE doo _ <br /> / 0 TANK CONDITION ( OOD POOR, HOLES) ccs" uyLQL, <br /> N r" <br /> . 1 S PIPE MATERIAL (STEEL, FIBERGLASS, <br /> P T OTHER) # FEET <br /> I WIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N i ,i s <br /> E K a, <br /> L <br /> D S EXCAVATION SIZE: X I& X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I ` <br /> P L P <br /> EI E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 N H DEPTH TO G. W. ; FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: G L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE; VOLUME: <br /> EH 2_30043 ( 10/69) DRAW SITE MAP ON REVERSE <br />