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PHS—EHD — UNDERGFJ0ND TANK CLOSURE/ABANDDNM INSPECTION <br />f <br />(S , HADED A . R - E . A TOM -NE -FILLED IN FOAR THE FIRSTA•NK ONLY) <br />. ... ... ... ... <br />OWNER-NAME■7 <br />OWNER PHONE # <br />J`3 <br />CONTRACTOR CON. PHONE# <br />9L <br />SJLHD PERMIT # <br />FIRE PERMIT # <br />RENCH DIMENSION X i 4�4 tq 19 X YDS OF SOIL- t 3 <br />=m-_- - ��7_ <br />0 H DEPTH T - <br />O G. FT SAMPLINGMETHODN a <br />0 # OF HOURS <br />SINGE DEWATERING: <br />f <br />0 OTHER SAMPLE: <br />VIA <br />MML SAMPLERS NAME:j�me5' defW'k <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) <br />I DRAW SITE MAP ON REVERSE <br />10 1k <br />RINSED Y I%W, METHOD RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />T # -OR- OTHER <br />VAPORS PURGED O/N) METHOD <br />AMOUNT USED/�-D <br />L.E.L. READING AT REMOVAL (MUST BE 20%) <br />T <br />COMMENTS <br />A <br />N <br />K <br />TANK MATERIA • L (STEEL <br />TANK SI■ZE <br />TANK CONDITION <br />P <br />lug d wr <br />N <br />Loan -loll, <br />G <br />SOIL TYPE OBSERVATION <br />F <br />I <br />E <br />L <br />DX <br />EXCAVATION SIZE: <br />X YDS OF SO• IL: <br />N <br />SOIL TYPE OBSERVATION <br />S <br />P <br />E <br />iii �'i <br />C <br />i�i�r;��..���.�► <br />RENCH DIMENSION X i 4�4 tq 19 X YDS OF SOIL- t 3 <br />=m-_- - ��7_ <br />0 H DEPTH T - <br />O G. FT SAMPLINGMETHODN a <br />0 # OF HOURS <br />SINGE DEWATERING: <br />f <br />0 OTHER SAMPLE: <br />VIA <br />MML SAMPLERS NAME:j�me5' defW'k <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) <br />I DRAW SITE MAP ON REVERSE <br />