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PHS-EHD - UNDERG TANK CLOSURE/ABANDONMEI! NSPECTI <br />(SHADED AREA To WDFILLED IN FOR THE FIRST RNK ONLY) I <br />E OWNER NAME �/� OWNER PHONE # �f� _ -/ <br />ECONTRACTOR CON. F�HONE# <br />R SJLHD PERMIT # EPA # FIRE PERMIT # <br />A <br />L <br />INSPECTORL' ®o <br />z" DATE 7- fo- gb TANK # 39 <br />R RINSED(ON) METHOD .,A`,i� RI NSE AMOUNT <br />N R I NSATE DISPOSAL SITE Civ o L o <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED N) METHOD y ��� AMOUNT USED os -p wogs <br />A <br />P L.E.L. READING AT REMOVAL (MUST RE < 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL �ELFIBERGLASS, OTHER) TANK SIZE <br />K C <br />/ 0 TANK CONDITION (GOOD,(O R HOLES) <br />N <br />X S PIPE MATERIAL ((STEED. FIBERGLASS OTHER) <br />P T # FEET <br />Q <br />I PIPING CONDITION (GOOD, BOOR HOLES) <br />N <br />G EH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />I N • • ` • I�JF <br />E K <br />L <br />D S EXCAVATION SIZE: 33 `X ?_ X ®a-• YDS OF SOIL: 04 Qp3 <br />I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N M P <br />S P I <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X X YDS OF SOIL.�,a <br />0 H DEPTH TO G. W.: FT SAMPLING METHOD <br />N _ ._ <br />G # OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />LABORATORY: �:s ��v®Y SAMPLERS NAME: a%g <br />CLOSURE IN PLACE MIXTURE:VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />