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PHS—EHD — UNDERUND TANK CLOSURE/ABANDONMT INSPECTION <br /> (SHADED. AREA Ir BE FILLED IN FOR THE FIRST TANK ONLY) <br /> My <br /> m . <br /> OWNER- NAM OWNER PHONE ' <br /> E rG N lo�0c 2 3.3r <br /> N CONTRACTOR P1 /� <br /> E <br /> CON. PHONE# llv, - Q — 75;4q9 <br /> f, <br /> R SJLHD PERMIT EPA # <br /> A . FIRE PERMIT # <br /> G, <br /> a <br /> INSPECTOR � � DATE // TANK # <br /> R RINSED (Y/NY METHOD RINSE MOUNT 175,0 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— <br /> OTHER <br /> V VAPORS PURGED (',Y/N) METHOD <br /> A AMOUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 2GX) <br /> D 3 -lv p <br /> T R COMMENTS <br /> A F <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / o TANK CONDITION (GOOD, FLOOR, ' 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 <br /> TSAMPLE �# <br /> F A <br /> I N S <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X X YDS OF SOIL: <br /> I A DEPTH . SOIL -TYPE OBSERVATION <br /> N M p SAMPLE '# <br /> S P I <br /> P L P 41 S <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 ME"CHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE:. <br /> C LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURG: ) <br /> VOLUME: <br />.H 23043 ( 10/89) .kDRAW SITE MAP ON REVERSE <br /> �R <br />