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PHS-EHD - UNDERGRt„ IND TANK CLOSURE/ABANDONME1 INSPECTION <br /> (SHADED AREA TO.Z FILLED IN FOR THE FIRST `"rANK ONLY) <br /> 9 <br /> E • OWNER NAME OWNER PHONE # <br /> N , CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EFA # <br /> A /rr FIRE PERMIT # <br /> r „ <br /> L <br /> INSPECTOR t'• yuf DATE <br /> TANK <br /> ,'2_ <br /> R RINSED Y N) METHOD <br /> I � RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE 3,3� <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD <br /> A �r� AMOUNT USED do 6 <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) ' <br /> Xo <br /> T R COMMENTS k <br /> A <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITIO (GOOD POOR, HOLES) �o0o dG <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET — <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION <br /> SAMPLE # <br /> F A f , - <br /> I Isco pti <br /> N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X `/� X <br /> S YDS OF SOIL : lei' Sok <br /> I ArS <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION - <br /> I YDS OF SOIL <br /> 0S, <br /> H DEPTH TO G. W. ; <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: WPsf �Crbs v/S SAMPLERS NAME: /(/fir ICNNA +I <br /> CLOSURE IN GLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />