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PHS—EHD — UNDERG•.,UND TANK CLOSURE/ABANDONMeTfT INSPECTION <br />(SHADED AREA TO�ypyB/EFILLED <br />I�N/ FOR THE <br />uyyFIRST <br />TANK <br />pyONLY) �yy <br />•/ � �iJYluLiitiLr����lG.W.iv�.piJulv�lrYL��"IL" 1pyy��JJ����JJ;,��,;,/r�:fl'.zilY.a�1L"!l"Yir71%7u'7/iYJi �y��ixyv��i��iyy/ <br />' ADOR� Q l <br />E ❑WNER NAME OWNER PHONE # <br />N <br />�CONPHONE <br />Cao � ?3- ?03 <br />ECONTRACTOR 7 10 <br />��O? 9,P3 -/354o <br />R .� SJLHD PERMIT # EPA # <br />A•/ FIRE PERMIT # <br />INSPECTOR <br />0S <br />I RINSED Y N) METHOD—� <br />RINS AMUU "f <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGED (Y N) METHOD <br />A ( AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST B < 20%) 5 <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIA STEE FIBERGLASS, OTHER) TANK SIZE <br />K C v <br />/ O TANK CONDITION (GOOD, OOR HOLES) <br />N <br />S PIPE MATERIAL QLTEE 1,;;:;, FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD, 0 HOLES) 1 J <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE # <br />F A <br />I N . <br />E K S <br />L <br />0 EXCAVATION SIZE: <br />S X X YDS OF SOIL: <br />I A 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 X <br />I X YDS OF SOIL <br />0 H DEPTH TO G.W.: <br />SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE INGLACE MIXTURE: <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />