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." . I I <br />PHS-EHD - UNDE*UND TANK CLOSURE/ABANDON* T INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />E <br />N <br />E <br />R <br />A <br />L <br />T <br />A <br />N <br />K <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />I <br />N <br />S <br />P <br />E <br />C <br />T <br />N <br />OWNER -NAME ( <br />CONTRACTOR <br />SJLHD PERMIT # <br />OWNER PHONE I <br />9— <br />CON. PHONE# <br />.EPA # FIRE PERMIT <br />PA <br />A <br />M <br />P <br />L <br />P <br />I <br />P <br />EXCAVATION SIZE: X -CL X OF SOIL: I - r- <br />- 71 <br />0 <br />DEPTH/' SOIL TYP OBSERVATION . . .. ..... . .............. <br />SAMPLE <br />ft <br />INSPECTOR <br />DAT # <br />R <br />I <br />RINSED N) <br />METHOD Tri pie %inseJ RINSE AMOUN-r,_50q, <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # <br />-OR- OTHER <br />V <br />A <br />VAPORS PURGED <br />METHOD -DL (O -Q t AMOUNT USED <br />H <br />2 <br />DEPTH TO G. W. eo a nnr FT <br />'�� <br />P <br />0 <br />L..6. L. READING <br />AT REMOVAL (MUST BE 20%) <br />R <br />COMMENTS <br />0 <br />OTHER SAMPLE: <br />TANK MATERIAL <br />TEEL,)FIBERGLASS, OTHER) TANK SIZE O 3 <br />0 <br />N <br />TANK CONDITION <br />(GOOD, OOR HOLES) Corrc-�5,,, ie <br />ev <br />S <br />T <br />PIPE MATERIAL , <br />TEE , FIBERGLASS, o-rHER)] # FEET <br />PIPING CONDITION (GOOD,, OOR, HOLES) C. roa I -c r1 e V c-tc Kj- <br />DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE <br />A r. <br />ne- jQc) i��,Ilnlncn-tlnn <br />N <br />K <br />om, ci I n <br />WN <br />A <br />M <br />P <br />L <br />P <br />I <br />P <br />EXCAVATION SIZE: X -CL X OF SOIL: I - r- <br />- 71 <br />0 <br />DEPTH/' SOIL TYP OBSERVATION . . .. ..... . .............. <br />SAMPLE <br />ft <br />I <br />E <br />- <br />N <br />7L <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />H <br />2 <br />DEPTH TO G. W. eo a nnr FT <br />SAMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: aacuwl ced LG'. <br />SAMPLERS NAME: <br />CLOSURE IN PLACE E: <br />1 VOLUME: 1-: -. I <br />EH 22043 (10/89) <br />DRAW SITE MAP ON REVERSE <br />I <br />