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PHS--EHD - UNDERC� JND TANK CLOSURE/ABANDONih., ,' INSPECTION <br /> (SHADED AREA TG BE FILLED IN FOR THE FIRST TANK ONLY) <br /> Uli <br /> TWINY <br /> E , . OWNER NAME OWNER PHONE # j <br /> N .y CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # <br /> 1 11EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR f- DATE TANK # 19 - aq - 3 <br /> R RINSED ) METHOD <br /> I �• RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHOD <br /> A v I7-�� AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 L+ F'•G. o/o <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C p J <br /> TANK CONDITIO (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> p T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A + rr r A/c /SCa n-tr N <br /> E K <br /> L <br /> D EXCAVATION SIZE: �O X <br /> S --L X .LV_ YD., OF SOIL: <br /> I ADEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P j <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; <br /> N FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> G � zlr&c SAMPLERS NAME- <br /> eel*- <br /> AjgA. <br /> CLOSURE IN PLACE MIXTURE: e <br /> VOLUhIE <br /> EH 22043 ( 14/89) DRAW SITE MAP ON REVERSE <br />