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PHS-EHD ---UNDr-'lGR' JD TANK CLOSURE/ABAND 4Et•. . <br /> (SHADED ARE�,/TO z'E FILLED IN FOR THE F 1 ST TANK INSPECTION ON <br /> / <br /> OWNER- NAME <br /> E 10� SG�rnv f` OWNER PHONE # <br /> N : CONTRACTOR •� <br /> E �� �� CON. PHONE# <br /> R SJLHD -PERMIT # <br /> q . ' � , EPA # FIRE PERMIT # <br /> J D,c <br /> INSPECTOR �, 0 v DATE <br /> TANK # "9 - is '3 - O/ <br /> R RINSED 1(/N) METHOD <br /> I SLI RINSE AMOUNT <br /> N R I NSATE DISPOSAL SITE /� `L <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED O/N) METHOD <br /> A ` / AMOUNT USED <br /> P L..E. L. READING AT REMOVAL <br /> 0 (MUST BE ( 20%)) /���' �s <br /> T R COMMENTS <br /> I A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, BOOR, OLES) v <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, OOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I <br /> N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: ,!Z ' � ' <br /> S X _ X .............. YDS OF SOIL: �3 <br /> I A DEPTH SOIL. TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I / i� <br /> P L P L /. <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SDIL <br /> O H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ( SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUhIE <br /> EH 227043 ( 10/89) DRAW SITE MAP ON REVERSE <br />