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PHS-EHD - UNDCRGROUr--� TANK CLOSURE/ABANDONMENT('1SPECT ION <br /> (SHADED AREA TO BL ,'ILLED IN FOR THE FIRST TA,vK ONLY) <br /> ti OWNER NAME OWNER PHONE #! / r <br /> Nus k r'n,+p .�o d <br />' N < CONTRACTOR / / CON. PHONE# 3 <br /> R S.ILHD PERMIT # EPA # FIRE PERMIT <br /> L MEN <br /> INSPECTOR C NuN �- DATEIO//s qI TANK 4 _39 - / 57;- <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I _ <br />' N RINSATE DISPOSAL SITE <br /> S ; <br /> E MANIFEST # -OR- OTHER <br /> i <br /> V VAPORS PURGED (Y/N) METHOD NA AMOUNT USED <br /> A <br /> P L.E. L. READING AT REMOVAL (MUST BE < 20%) ` <br /> ' 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATCRIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE _ 7 <br /> K C <br /> / Cl TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> ' S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) 0 FEET <br /> p T <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> ' 3 DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T ' CY�or ,sC n l id N� r 1 N <br /> A + <br /> N — <br /> K <br /> I EXCAVATION SIZE: � X L X YDS OF SOIL: <br /> ' S <br /> .�: 3d GAS <br /> A DEPTH SOIL TYPE OBSERVATION SAMPLE it <br /> M P <br /> ' P I <br /> L P <br /> I E <br /> ' N <br /> G TRENCH DIMENSION X X YDS f1f' SOIL _�.. <br /> H DEPTH f0 G. W. : FT SOMPLING ML SHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLC: , <br /> q, ,� s <br /> i LABORATORY . 1- fn , aOMPLCAS NFIrriC <br /> CLO`JuitC Ir NLf)CC M I XTUnC VOLUME <br /> O ,,i ( 10/tV)) '1Aflw a l rt Mf d) ON n[-k)1 Qr-C <br />