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PHS-EHD - UNDERG, -JND TANK CLOSURE/ABANDONMEw1" INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> /�i7u a r r a <br /> -14 <br /> 1 P A <br /> OWNER NAME S OWNER PH NE # <br /> E <br /> N CONTRACTOR <br /> E �IOC v �� r CON. PHONE# <br /> / el (',,0q <br /> R SJLHD PERMIT # <br /> R EF'q # FIRE PERMIT #J <br /> L <br /> INSPECTOR 71 PS DATE �I I/ -] TANK # 39 - J - d - <br /> R RINSED (Y/N) METHOD RINS AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # _ _ -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHO AMOUNT USED <br /> A Ib <br /> P L. E. L. READING AT REMOVAL (MUST ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL q STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD,fO OLES) Iw-(Q Jh 5;, he' ll Pi <br /> N - <br /> S F'IF'E MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> NPIPING CONDITION (GOOD, POOR, HOLES n'o - / 0"o <br /> T � o <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A 4 ) <br /> I N T *Z a kJ <br /> E K 7 <br /> L <br /> D EXCAVATION SIZE: X 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 /> I -- -- <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N -------- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> ir <br /> LABORATORY: � wq�- jZ-cax SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />