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PHS-EHD - UNDERAND TANK CLOSURE/ABANDONM <br /> � (SHADE,,D// AREA TO BE FILLED IN FOR THE FIRST TANK ONLY)INSPECTION <br /> ��/ i%W r���'���'fir'iii i/�vui%//��r ,r .�r�•lu��� ,�/ /� b.G` fl �1.�'/ .,(�. <br /> OWNER NAMEc. +? <br /> E DWNER PHONE # <br /> N CONTRACTOR <br /> E <br /> L4q _� CON. RHONE# <br /> R SJLHD PERMIT # FTA # <br /> A EFIRE PERMIT # y� <br /> INSPECTOR71 <br /> DATE Gji - � TANK # 39 <br /> R RINSED (Y N) METHOD �- <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> --OR- OTHER : <br /> V VAPORS PURGED (Y N) METHOD <br /> A <br /> l� } [ AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST PE < 2GX) <br /> &ZLGL- <br /> T R COMMENTS y <br /> A <br /> N TANK MATERIAL S7E�1 , FIBERGLASS, OTHER) TANK SIZE <br /> / O TANK CONDITION (GOOD, F��OOR <br /> N s ,)HOLES) <br /> j S PIPE MATERIA STEE , FIBERGLASS, OTHER) # F ET <br /> R T <br /> I PIPING CONDITION (GOOD <br /> N , BOOR OLES) ' <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A 't@nr <br /> I N C <br /> E K ,fir s <br /> Lf <br /> rt r,exp. f— <br /> D EXCAVATION SIZE: IX- <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> R L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X - X �_ YDS OF SOIL <br /> O H DEPTH TO G. W. : � � FT <br /> N SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: 4?-45 , . ./ SAMPLERS NAME:E& <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME; <br /> 7H 23043 ( lo/Sq) DRAW SITE MAP ON REVERSE <br />