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PHS--EHD - UNDERUROL� <br /> � TANK CLOSURE/ABANDONMEN'iNSPECTION <br /> (SHA�yDED� AREA TO BE FI LLED IN FOR THE FIRST TANK ONLY) <br /> I �L3�������.lii7,v"`l"rr."lv�.�i�.v�� <br /> OWNER NAME OWNER ' <br /> E rct r,/< PHONE # <br /> NC'CONTRACTOR <br /> E CON. PHONE# <br /> R .s 53LHD P MIT # E� #'��'���'�vy <br /> A . FIRE PERMIT <br /> L <br /> INSPECTOR DATEg c TANK # g <br /> /tel�a ------__ - __ 2'Q <br /> R R I LASED N) METHOD <br /> RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED YA) METHOD <br /> A AMOUNT USED �irol6s <br /> L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N T' TANK MATERIA <br /> K C, /COTEEL, FIBERGLASS, OTHER) TANK SIZE <br /> SOV sCC.� <br /> N` TANK CONDITIO , POdR H LE' <br /> s <br /> S, PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T - <br /> I PIPING CONDITION (GOOD <br /> N , POOR, HOLES) <br /> ' <br /> Gf' DEPTH SOIL TYPE OBSERVATION <br /> !, T SAMPLE # <br /> F "A <br /> I N <br /> EK <br /> L <br /> D 1` EXCAVATION SIZE: �� � <br /> S' X - X YDS OF SOIL: ra Y�3 <br /> I A � DEPTH SD TYPE OBSERION <br /> T <br /> N MI' P SAMPLE # <br /> p L iE P <br /> E I E <br /> C N . <br /> T Gr TRENCH DIMENS N <br /> I i X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : � FT <br /> N 2 SAMPLING METHOD �iuss A,Lcs <br /> G # OF HOURS SINCE DEWATERING: <br /> �. 0 OTHER SAMPLE: <br /> LABORATORY: Cf 7 _�_ -y /"� SAMPLERS NAME:IL <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 2304311� ( I0/89) DRAW SITE MAP ON REVERSE <br />