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PHS-EHD - UNDERJUND TANK CLOSURE/ABANDONPOT INSPECTION <br /> (SHADED AREA T BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OW NAME �a / T�� OWNER PHONE # j <br /> qS3- 8/mob <br /> N CONTRACTORR� CON. PHONE# <br /> E <br /> R SJL -OEPA <br /> A • � # <br /> FIRE PERMIT # <br /> So/L f3o�2i (s- <br /> INSPECTOR ATE TANK # 39 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A AMOUNT USED <br /> P L. E. L. READING AT REMOVAL <br /> O (MUST RE < 20%) <br /> T R COMMENTS <br /> A <br /> NTANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T BANGLE # <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> I <br /> P L Op �!L roLoF!^ <br /> G <br /> C N E <br /> T G TRENCH DIMENSION Z <br /> I — X -- X YDS OF SOIL � � �Z <br /> 0 H DEPTH TO G. W. ; <br /> N FT SAMPLING METHOD 1441VD �I] <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> �o4kf5, <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 213043 ( 10/89) DRAW SITE MAP ON REVERSE <br />