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PHS--EHD - UNDERG{ D TANK CLOSURE/ABANDONMl` ,$)INSPECTION <br /> F (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> go <br /> 7OWNER- N7AMEOWNER PHONE # <br /> 7rN <br /> CTOR CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A • , <br /> L <br /> a r i <br /> INSPECTOR DATETANK # 39 - <br /> R RINSED (Y/N) METHOD RINSE AWOUN7 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # `{ -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE 5 s i <br /> K C <br /> / O TANK CONDITION (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 SAMPLE # <br /> T <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S F <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <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 14-E TH TO G. W. : FT SAMPLING METHOD <br /> N <br /> F HOURS SINCE DEWATERING: <br /> s. <br /> 11 OTHER SAMPLE: <br /> LABORATORY: cC- SAMPLERS NAME: <br /> _ da2 /ah4 <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />