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• <br />PHS–EHD – UNDERGRf&D TANK CLOSURE/ABANDONMEl' INSPECTION <br />(SHADED AREA TO FILLED IN FOR THE FIRSTVNK ONLY) <br />" 12, AlMl <br />rg <br />e <br />OWNER -NAME OWNER PHONE # <br />E xe ® <br />P <br />N CONTRACTOR . HONE# <br />E 66IV5�-' CON/I <br />R SJLHD PERMIT # <br />A. FIRE PERMIT # <br />L <br />INSPECTOR 14.1 DATE TANK # 39 _Z il'-1;7— O:Z <br />R RINSED tY METHO RINSE AMOUNT <br />I <br />N RINSATE DISPOSAL SITE <br />S --m <br />E MANIFEST # –OR– OTHER <br />V VAPORS PURGED Y N) METHOD <br />A AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 <br />T R COMMENTS <br />A...... <br />N TANK MATERIAL (STEEL, CFIBERG <br />K C OTHER)LASS TANK SIZE <br />0 TANKEll - ---*.Nmmmmmmm- <br />N CONDITION GOOD,POOR, HOLES) <br />S PIPE MATERIAL (STEEL, IBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T - — / I — I At, SAMPLE # <br />F A <br />I N <br />E K <br />L <br />D S EXCAVATION SIZE: -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 X <br />I P — x YDS OF SOIL <br />0 H DEPTH TO G. W.: FT SAMPLING METHOD <br />N a -- <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY -SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />=00m -- <br />EH 23043 (10/89) <br />DRAW SITE MAP ON REVERSE <br />