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PHS- -- UNDERGD TANK CLOSURE/ABANDONME . . .. INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST "TANK ONLY) <br /> IM W <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR LQ'(' ` <br /> R RINSED (Y N) METH RINSE AMO T <br /> I , <br /> lie <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -DR- OTHER <br /> V VAPORS PURGE (Y N) METHOD AMOUNT USED <br /> A SO <br /> P L.E.L. READING AT REMOVAL (MUST ILd < 20%) <br /> 0 <br /> T R COMMENTS <br /> A y <br /> N TANK MATERIA (STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> 0 TANK CONDITION J�OOD POOR, HOLES). <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> P T # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: X <br /> S X I YDS OF SOIL: <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 DIMENSION X X YDS OF SOIL <br /> i <br /> O H DEPTH TO G. W. <br /> N _ FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> D OTHER SAMPLE: <br /> LABORATORY: C SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />