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4 <br /> PHS-EHD - UNDERL. " 'ND TANK CLOSURE/ABAND \ <br /> (SHADED AREA T0 BE FILLED ONM INSPECTION <br /> D I N FOR THEy�FIRST TANK ONLY) ' <br /> E <br /> ERNAME OWNER PHONE # , <br /> N , CONTRACTOR <br /> E C CON. PHONE# <br /> R SJLHD PERMIT # <br /> A EPA # F;IRE PERMIT # <br /> L , <br /> .F <br /> INSPECTOR DATEp ' <br /> j Q l p TANK <br /> R RINSED (Y N) METHOD <br /> I ; RINSE AfJOUNT� <br /> N RINSATE DISPOSAL SITE <br /> S �� I <br /> E MANIFEST # <br /> -OR- OTHER f <br /> V VAPORS PURGED (Y ) METHOD <br /> A AMOUNT USED a p <br /> ;L <br /> P <br /> L. E. L. READING AT REMOVAL (MUST BE (. 00;x) <br /> 0 <br /> T R COMMENTS <br /> A !� <br /> N TANK MATERIAL TE , , OTHER), TANK SIZE 5 <br /> K C FIBERGLASS50 I <br /> / O TANK CONDITION OD POOR, HOLES) ° <br /> N vi <br /> S PIPE MATERIAL (STEEL; FIBERGLASS, OTHER)l # FEE"f <br /> P T t <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL, TYPE OBSERVATION <br /> T ; SAMPLE # t <br /> F A S; { <br /> A. <br /> I <br /> N <br /> E K <br /> L <br /> ,w <br /> D EXCAVATION SIZE: <br /> 2L x L y//__ i <br /> S x .. YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P , <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 3 <br /> O H DEPTH TO G. W. : � FT <br /> N 2 SAMPLING METHOD s <br /> G # OF HOURS SINCE DEWATERING- <br /> ' t <br /> O OTHER SAMPLE: <br /> LABORATORY: - SAMP-LERS NAME: t <br /> �L <br /> CLOSURE IN PLACE MIXTURE: <br /> ;s VOLUME: <br /> 7-H 53043 ( 10/89) , <br /> DRAW SITE MAP ON REVERSEI <br />