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PHS-EBD - UNDE' '+..JUND TANK CLOSURE/ABANDON 4T INSPECTION <br /> (SHADED AREA ' rO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER• NAME DWNE PHONE # ' <br /> A <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A • � <br /> L <br /> INSPECTORS f'616DATE leo # ?,q <br /> R RINSED EY N) METHOD RINSE AMOUNT� / <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> —CR— OTHER <br /> V VAPORS PURGED . Y/N) METHOD / <br /> A /Gp AMOUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST BE �G;cl �, S=L?Z 1 L <br /> O ez <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE ; FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> D TANK CONDITIpN (GOOD, DOR } H—, <br /> N ES) <br /> j' S PIPE MATERIAL , FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATID <br /> T SAMPLE # <br /> E K a X1tin <br /> L <br /> D EXCAVATION SIZE: �p <br /> S � X •' X YDS OF SOIL: <br /> I A DEPTH SOIL TYPe OBSERVATION <br /> N M P SAMPLE # <br /> S P I t <br /> P L P / <br /> E I E 'Z <br /> C N <br /> T G TRENC DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO G. W. : FT <br /> N AMPL I NG METHOD <br /> - <br /> 0 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: J <br /> LABORATORY: —' <br /> << ��`l,S SAMPLERS NAME: �, <br /> 1—;la n-Ar <br /> CLOSURE IN PLACE MIXTURE: N�, VOLUME.- <br /> EH <br /> OLUME:EH 2303 ( 10/89) DRAW SITE MAP ON RE-VERSE <br />