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PHS-EHD - UNDE ,OUND TANK CLOSURE/ABANDD NT INSPECTION <br /> (SHADEyD�/�yYA�,REA' TO�/,ylryB�EFILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER- NAME OWNER PHONE # y ' <br /> N CONTRACTOR <br /> E S CON. PHONE# <br /> X04 <br /> R � SJLHD PERMIT # EPA # <br /> FIRE PERMIT # <br /> L <br /> INSPECTORD <br /> 1117. DATE O Jo (�L11 ' TANK # u9 <br /> R RINSED (Y N) METHOD <br /> I T ��" RINSE AM UNT S`5" <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED N) METHOD <br /> A r► 1 AMOUNT USED <br /> P L-E. L. READING AT REMOVAL (MUST B ( 20%) 1 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEEL FIBERGLASS, <br /> K C OTHER) TANK SIZE <br /> O TANK CONDITION (GOOD, 'DOR HOLES) <br /> N � • � <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I � <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE ' OBSERVATION T SAMPLE # <br /> F A <br /> z <br /> K <br /> U <br /> E <br /> L # tJ <br /> D EXCAVATION SIZE: / <br /> S 3Y—) x X sYDS OF SOIL: <br /> Z A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE' # <br /> S P I n <br /> P L P n <br /> E I E c; <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I - YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; <br /> N ;a ----.-- FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> v OTHER SAMPLE; <br /> LABORATORY: CAS. W f-EI] / SAMPLERS NAME -D <br /> CLOSURE IN PLACE MIXTURE!: f` `�Gt <br /> VOLURIE: <br /> EH 23443 (10/89) DRAW SITE MAP ON REVERSE`: : <br />