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PHS-EHD - UND' JROUND TANK CLOSURE/ABANDAENT INSPECTION <br /> (SHAVED ARES TOBE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER- NAME <br /> E OWNER PHONE ## <br /> N CONTRACTOR ,A y <br /> 0f u ' <br /> E "y S , <br /> CON. F HONE# � 9 �� <br /> R SJLHD PERMIT # <br /> IV <br /> A • ', EPA # <br /> . FIRE PERMIT # a <br /> �^ r <br /> INSPECTORLt+i i' DATE n <br /> SC � IO ` j) TANK # <br /> R RINSED Y N) METHOD <br /> I RINSE A OU ss I <br /> N RINSATE DISPOSAL SITE <br /> S ; <br /> L MANIFEST # <br /> -OR- OTHER <br /> V VAPORSPURGED (Y/N) <br /> A METHOD AMOUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST BE <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA <br /> K C C - FIBERGLASS, OTHER) TANK SIZE <br /> 0 TANK CONDITION (GOOD <br /> N , POOR HOLES) <br /> S PIPE MATERIAL (STEEL,' FIBER <br /> P T GLASS; OTHER) # FEET <br /> I <br /> N PIPING CONDITION (GOOD, POOR, HOLES) <br />- <br /> G T DEPTH SOIL TYPE OBSERVATION <br /> F SAMPLE # <br /> N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X --�-- X YDS OF SOIL: <br /> 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 <br /> I X -_ X YDS OF SOIL <br /> N H DEPTH TO G. W. : �� FT <br /> SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> w LABORATORY: ,� k-4 /5 SAMPLERS NAME: <br /> CLOSURE IN PLACE- MIXTURE: U <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MFlP ON REVERSE <br />