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PHS-EHD - UNDERGRdw TANK CLOSURE/ABANDONMENONSPECTION <br /> (SHA[yDEyyD[ AREA TO BE yFILLED IN FOR THE FIRST TANK ONLY) � <br /> OWNER NAME lI l OWNER PHONE # <br /> E <br /> N CONTRACTOR �. � G, CON. PHONE# �G' �� _ 33 <br /> E Flu <br /> R SJLHD PERMIT # EPA # FIRE PERMIT ii brd CC'SF <br /> A i <br /> L / <br /> INSPECTOR DATE DATE lt; TANK # 39 <br /> R RINSED (Y(N) METHOD fJ RINSE AMOUNT Nif� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> s <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD '� AMOUNT USED <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R 1 COMMENTS <br /> A <br /> N TANK, MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE �00(7 <br /> / 0 TANK CONDITION POOR HOLES) ND l003 LO n Fi46 <br /> N <br /> }ds- <br /> S PIPE MATERIAL (( TEEL FIBERGLASS, OTHER) # FEET /o x <br /> P T <br /> I PIPING CONDITION dOOD POOR, HOLES) �41 ' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A C <br /> I N 1 c9 <br /> E K <br /> L <br /> D EXCAVATION SIZE: ham' . X 1Q 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 XX YDS OF' SOIL <br /> I -- -- <br /> OH DEPTH TO G. W. hbTL FT�I�, SAMPLING METHOD N! - <br /> N h 2 1 <br /> V # OF HOURS SINCE DEWATERING: ti -� <br /> Ll <br /> ❑0 OTHER SAMPLE: NIS- <br /> LABORATORY: -AL- b, I SAMPLERS NAME : <br /> CLOSURE IN F'LACE MIXTURE: N VUI_UME: h <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />