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( �r <br /> PHS-EHD - UNDERGROUN, TANK CLOSURE/ABANDONMENT 1i�6PECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> f!/�:�(Gl'G/!'G,�JO ifz%�Gi1'/, l/ �f/i17, 'i'�/it�/ iJ�/i! r'G, <br /> I �uur �uwru�ruiuruiuiuiui�w wurivuriuuriu moi"�G" �r�tY ruiuiuiurauriu uiuiuiuiuir�rjr(v{(iuiai rGiu�. 'unM P <br />'r , OWNER NAME OWNER PHONE # <br /> 1 E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R ,� SJLHD PERMIT # 6!EPA # FIRE PERMIT # 3 � <br /> INSPECTOR , E' �ti� DATE S-3- �l TANK # ?9 — —2 SSD 9 — <br /> R RINSED (Y ) METHOD p RINSE OUNT <br /> I ,mss,-u.c, i )r <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> FRVAPORS PURGE (Y ) METHOD �r� AMOUNT USED <br /> L. E. L. READING AT REMOVAL (MUST BE < 20%) �c� L.T COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) I TANK SIZE <br /> K C <br /> ! 0 TANK CONDITIO (GOOD, 00R, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> i G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> i <br /> i F A` -2 ' <br /> I N r No <br /> i E K <br /> L <br /> j D EXCAVATION SIZE: g� X ��r X cr YDS OF SOIL: ., <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> j E I E <br /> C N <br /> iT G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> i 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> n OTHER SAMPLE: <br /> L L!ARORATORY: �-�L SAMPLERS NAME :/j4 k nr <br /> CLOSURE IN PLACE MIXTURE: ` VOLUME : L <br /> I <br /> `H 2.304.3 ( 10/89) DRAW SITE MAP ON REVERSE <br /> r <br />