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PHS-EHD - UNDERL( 'JND TANK CLOSURE/ABAN' QNM INSPECTION TANK ONLY) <br /> (SHADED AREyA� T ypUU,, gEF��I y�L�yLy,E/D IN�� FOR THE F,yIR�S/T <br /> OWNER NAME <br /> E OWNER PHONE # <br /> N , CONTRACTOR k <br /> E C '.� CON. PHONE# <br /> R SJLHD PERMIT # EPA # \ 1 <br /> A ' r r FIRE PERMIT # F-!' ' <br /> L <br /> INSPECTOR + DATES �) f J <br /> TANK # w9 <br /> R RINSED Y N) f <br /> METHOD !� r <br /> I R I NSE AMOU�I I <br /> N RINSATE DISPDSAL SITE g Jt�✓ <br /> S <br /> E MANIFEST # <br /> -OR-- OTHER <br /> V VAPORS PURGED (Y/ } METHOD <br /> � _ I - AMOUNT USED,S Q/ <br /> ' L..E. L. READING AT REMOVAL (ML ST�� < �G } /Dt� <br /> O k I <br /> T R COMMENTS <br /> N TANK MATE <br /> K C =STEELFIBERGLASS, OTHER)+ TANK SIZE <br /> 0 TANK CONDITION GOOD POOR, HOLES) l <br /> N hu,Ste 0 <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE"f ' <br /> P T <br /> I <br /> PIPING CONDITION (GOOD, F+OOR$ HOLES) <br /> N <br /> GE' <br /> DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A S <br /> I N <br /> E K , <br /> L <br /> D EXCAVATION SIZE: ILA r ° <br /> S X x YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # � <br /> S P I <br /> P L P i <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION + <br /> I X x YDS- OF SOIL <br /> Qk <br /> H DEPTH TO G. W. : <br /> N - _ FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: ii <br /> 0 OTHER SAMPLE: . ' <br /> LABORATORY: SAMPLERS NAME: / ._C4k l <br /> CLOSURE IN PLACE MIXTURE: i <br /> VOLUME: <br /> EH 23043 ( 10/89) <br /> DRAW SITE .MAP ON REVERSE# ' <br /> E <br />