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' PHS-EHD - UNDERt. JND TANK CLOSURE/ABANDONA <br /> (SHADED AREA TL BE FILLED IN FOR THE FIRST TANKONLY) <br /> E OWNER NAME OWNER PHONE # <br /> N .y CONTRACTOR / <br /> E CON. PHONE# <br /> R ! SJLHD PERMIT # EFA # <br /> A FIRE PERMIT # <br /> / / / <br /> INSPECTOR N 1_ DATE TANK # 39 - <br /> R RINSED ( /N) METHOD <br /> I �Stu�t ls� RINSE AMOUNT sd <br /> N RINSATE DISPOSAL SITE ,` L 7 <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD _71�- AMOUNT USED <br /> /So/x_ <br /> G L. E. L. READING AT REMOVAL (MUST E ( 2UX) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C 1�g � <br /> / 0 TANK CONDITION (GOOD, 'OOR, HOLES) <br /> N N c' <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE'fE- <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> A, � � SAMPLE # <br /> F N ,fr <br /> E K <br /> L <br /> r' e P'JCfC�Y ON <br /> D EXCAVATION SIZE: <br /> S -vt,- X il X ..1!1_ YDS OF SOIL: �s S <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 DIMENSIONX X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. <br /> N FT SAMPLING ME-fHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> 4'6� SAMPLERS NAME- ,o <br /> CLOSURE <br /> IN PLACE MIXTURE: C�cr(j�ry <br /> V OLURIE: <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />