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PHS-EHD - UNDER*ND TANK CLOSURE/ABANDONM* INSPECTION <br /> (SHADED AREA TQ_I}E FILLED INFORTHE FIRST TANK ONLY) <br /> E OWNER NAME OWNER PHONE # <br /> R <br /> E , < CONTRACTOR`G!d Itldd&?y &&Ae& CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A - <br /> L <br /> INSPECTOR ' S DATE # 39 - - �-- <br /> R RINSED (Y/N) METHOD RINSE AM --r , $ <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> AV VAPORS PURGED (Y ) METHOD U-1AMOUNT USED ) O <br /> O L. E. L. READING AT REMOVAL (MUST B ( ,'_'0%) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE 5 b D <br /> K C <br /> / N TANK CONDITION (G00 , POOR, HOLES)v <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 a 7' 1 <br /> I N <br /> E K d <br /> L <br /> D S EXCAVATION SIZE: X �X YDS OF SOIL: <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 OF SOIL <br /> I — — <br /> 0 H DEPTH TD G. W. : FT SAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> �Ul LABORATORY: �� ;�j - ) _ J SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />