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PHS—EHD — UNDERGROU <br /> �°"*)TANK CLOSURE/ABANDONMENT r?SPECT I ON <br /> (SHADED AREA TO BL—,- ILLED IN FOR THE FIRST TA YK ONLY) <br /> ,zi�.,��. , ,KfSh�`� ��'w`w�,� �,L�i,�,f...L.�, , <br /> E OWNER NAME <br /> j OWNER PHONE q j <br /> N ! CONTRACTOR CON. PHONE# <br /> E y <br /> R a SJLHD PERMIT # EPAf ii FIRE PERMIT (i Q <br /> ryyt' It ,I / r�r , � F <br /> INSPECTORC �U+��— GATE f 0 fi�— TANK # <br /> R RINSED {Y/N) A METHOD RINSE AMOUNT i <br /> I I , <br /> s <br /> N RINSATE DISPOSAL S.TE ; <br /> S ')'nGl��r <br /> E MANIFEST 0 —OR-- OTHER <br /> VVAPORS PURGED (Y/N)N� METHOD AMOUNT USED <br /> A s <br /> F' L.,E.L. READING AT REMOVAL (MUST BE 120%) <br /> O <br /> R COMMENTS <br /> A <br /> TANK MATCRIAL (STCEL, FIBERGLASS, OTHER) TANK SIZE <br /> C � QQD <br /> O TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL. FIBERGLASS, OTHER) T# FEET <br /> 3 T <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE I OBSERVATION SAMPLEN <br /> T <br /> r •, C .2C <br /> K <br /> EXCAVATION SIZE: ?�! X � ; X YDS SOIL: <br /> �rrU.�► d <br /> YDS OF <br /> S <br /> A SOIL 'TYPE OBSERVATION SAMPLE a <br /> Mrp—im <br /> ALI <br /> r J— <br /> N <br /> sG TRENCH DIMENSION X X YDS OF SOIL J <br /> I H DEPTH C0 G. W. : _ _—_ FT Sf1hiFL I NG ML fHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLC: <br /> LAUOf(ATORY: <br /> CLOSURE IN PLf10E �M_, XTUPC: <br /> _ VULUr ._ ! <br /> Li - <br /> u4;3 01111W `_l rL <br />