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PHS-EHD -- UNDER*UND TANK CLOSURE/ABANDONMPT INSPECTION <br /> (SHADED AREA TU BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME OWNER PHONE # R <br /> E I <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R f SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> I NSPECTOR, DATE -/Z-CSC. TANK # <br /> R RINSED (Y/N) METHOD RINSE AMOUNT r <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # 4 5 C, —OR— OTHER1_,fv _ <br /> V VAPORS PURGED 6)/N) METHOD l7n, tcc AMOUNT USED <br /> A <br /> p L. E. L. READING AT REMOVAL (MUST BE ( 20%) f " <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTE <br /> K C EL FIBERGLASS, OTHER) TfiNK SIZE <br /> �- - <br /> / O TANK CONDITION (GOOD, ( HOLES)R R; <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 SAMPLE # <br /> F A 1 - 1 <br /> I N _ 1 <br /> E K <br /> L <br /> D EXCAVATION SIZE: o X � D <br /> S X r YDS OF SOIL: 115 <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 X X YDS Oiz SOIL <br /> O H DEPTH TD G. W. : F T SCIMPL I NG METHOD <br /> N _ _ _ <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY;(- <br /> SAMPLERS NAME <br /> SAs 5 5 <br /> 1pelell 1 1�toS�c <br /> CLOSURE IN GLACE MIXTURE: 1A- i. UL1LUML • �/ <br /> EH 2.043 ( 13/89) DRAW SITE MAP ON REVERSE <br />