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PHS-EHD - UNDERGR�D TANK CLOSURE/RBRNDONMEN'*INSF'EC1-101\1 <br /> • <br /> (SHADED <br /> // AREA <br /> TO Ft yFILLED IN FOR THE <br /> FIRST TANK <br /> // ONLY) <br /> ZCONTRACTOR <br /> selmI ,mu 7u�UliM�u y�(r5'ME n / OWNER PHONE #cvrCON. PHONE# ��� )�f /RMIT # EFSu_aFIRE PERMIT # <br /> INSPECTOR �;OZ _ DATE /3 j�3 TANK. # 39 <br /> R RINSED (Y N) METHOD �EL RINSE AMO NT <br /> I S _ fru <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # /2uu -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD J` AMOUNT USED S <br /> R <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( EE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION ( 00 , POOR, HOLES) <br /> N <br /> S PIPE MATERIAL �STEE , FIBERGLASS, OTHER) # FEET i <br /> P T <br /> I PIPING CONDITION G00 , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: IGS rX -� X , 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 /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL_ <br /> D H DEPTH TO G. W. : FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑0 OTHER SAMPLE: <br /> HlLABORATORY: �C{�`{ , (�� {, ph - SAMPLERS NAME: <br /> 11 CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />