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N <br />E <br />R <br />A <br />L <br />T <br />A <br />N <br />K <br />/ <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />I <br />N <br />S <br />F' <br />E <br />C <br />PHS-EHD - UNDEV_�OUND TANK CLOSURE/ABANDONhTENT INSPECTION <br />11 (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />OWNER NAME OWNER PHONE # <br />9y�- CONT <br />RA <br />CTOR S CON. PHONE# <br />SJLHD PERMIT # EPA # FIRE PERMIT # <br />INSPECTOR DATE TANK # 39 <br />RPRINSSATE <br />ED (Y N) METHOD <br />I <br />N DISPOSAL SITES <br />EFEST # -OR- OTHER <br />VRS PURGED �Y%N) METHOD -A P L. READING AT REMOVAL (MUST B ( cUX) <br />O <br />R COMMENTS <br />C TANK MATERIA (STEE FIBERGLASS, OTHER) <br />0 TANK CONDITION (GOOD OOR HOLES) <br />N <br />S <br />T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION <br />T <br />A <br />N ! I .� u <br />K <br />S L- <br />A <br />M P <br />P I <br />L P <br />I E <br />N <br />RINSE <br />AMOUNT USED a <br />U44 gQi 1. 7o LEL-15 <br />TANK SIZE <br />1rv0u,'ybleti,�,es <br /># FEET <br />SAMPLE # <br />EXCAVATION SIZE: iL, X X <br />YD., OF .,OIL: <br />DEPTH SOIL TYPE OBSERVATION <br />SAhIF'LE # <br />TG TRENCH DIMENSION <br />0 H DEPTH TO G. W.: FT <br />N — SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: ,� qq y�� �� h K j� �y SAMPLERS NAME: <br />CLOSURE IN GLACE MIXTURE: <br />VOLUME: <br />EH 3043 (10/89) DRAW SITE MAP ON REVERSE <br />