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PHS—EHD — UNDERG`,,UND TANK CLOSURE/ABANDONMETP,'T INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />E OWNER NAME OWNER PHONE # <br />Cao a k3- 803 <br />N CONTRACTOR <br />E <br />R SJLHD PERMIT # EPA # FIRE PERMIT # <br />A r ' <br />r/ u <br />INSPECTOR 4/ `� A DATE - TANK # 39 —� <br />R RINSED ( /N) METHOD r/LT` RINSE AMU NT <br />I <br />N RINSATE DISPOSAL SITE <br />S ` <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGED (Y/N) METHOD <br />R AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE ( OUX) e;-. <br />S <br />0 <br />T R COMMENTS <br />R <br />N TgNK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br />K 0 / 60 <br />/ N TANK CONDITION (GOOD, POOR HOLES) r,4Ll5f �/ <br />S PIPE MATERIAL TEE , FIBERGLASS, OTHER) I # FEE'f <br />P T <br />I PIPING CONDITION (GOOD, DOR HOLES)/,, <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE # <br />F A <br />I N <br />E K 1 <br />L <br />DEXCAVATION SIZE: <br />g 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 <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 GLACE I MIXTURE: <br />VOLUME: <br />EH 3043 (10/89) DRAW SITE MAP ON REVERSE <br />