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PHS-EHD - UNDERE�,UND TANK CLOSURE/ABANDONMC�iT INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />,, OWNER NAME <br />a <br />E OWNER PHONE <br />N CONTRACTOR{� l� <br />E YJ, CIiG!/L CON. F HONE# /� �Gr 9�' 3 _ /3 elao <br />R SJLHD PERMIT # EPA # <br />A FIRE PERMIT # <br />INSPECTOR <br />0cZ <br />R RINSED Y N) METHOD <br />I j RINSE RML? NT <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED (Y N) METHOD <br />A 1 (,Q AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL FIBERGLASS OTHER) TANK SIZE <br />K C Ia boo 'tE <br />/ 0 TANK CONDITION (GOOD, OR, HOLES)u <br />N� <br />S PIPE MATERIAL TEE FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD, OOR HOLES) <br />N �'t,LvA Gi.t e <br />G DEPTH SOIL TYPE 0)}S�RVATI N <br />T SAMPLE # <br />F A <br />I N <br />E K l <br />L <br />D EXCAVATION SIZE: <br />S X X YDS OF SDIL: <br />I A DEVTH SOIL TYPE $SE VA, 0 <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 X X YDS OF SOIL <br />0 H DEPTH TO G.W.: FT <br />N SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />VOLUPIC <br />EH 23043 (10/99) DRAW SITE MAP ON REVERSE <br />