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f ' <br /> PHS-EHD' . UNM` gRQUND TANK CLOSURE/ABANDC ENT INSPECTION <br /> (SHADED AREA%oo O BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER- NAME <br /> OWNER PHONE # ' <br /> E /03- �Gy/ <br /> E •y CONTRACTOR S F.- �S ' <br /> wic CGN. PHONEi <br /> R V/I SJLHA PERMIT # <br /> A • EPA # FIRE PERMIT # a <br /> L <br /> al <br /> .( <br /> INSPECTOR�"t`f'�• f -� <br /> 3C DATE TANK # :,q - <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT � <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR-- OTHER <br /> V VAPORS PURGED (Y/N) <br /> A ME OD AMOUNT USED <br /> P L. E. L. READING AT .REMOV <br /> 0 (MUST BE ( E0;c <br /> T R COMMENTS - <br /> A q�S glee <br /> N TANK MATERIAL (S -EL, FIBERGLASS <br /> K C , OTHER) TANK SIZE <br /> O TANK CONDITIO (GOOD, POOR, HOLES) 4 <br /> N <br /> S PIPE MATER AL (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 <br /> I N <br /> . E <br /> L K <br /> D <br /> EXCAVATION SIZE: oZ X <br /> S � 2-,Z X 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 <br /> I — X X YDS OF SOIL <br /> N DEPTH TO G. W. ; �� FT <br /> SFIMPL i NG METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: e4L 4 bs SAMPLERS <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />