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PHS-EHD - UNDERAND TANK CLOSURE/ABANDONM& INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> a <br /> E #, OWNER NAME OWNER PHONE <br /> E o�09)�/G� S '.�rr5/ •� <br /> E , < CONTRACTOR G��/ �+ lt/yl� 'e CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR 11!iJil leiii ATE /f !� c��j TANK # 39 <br /> R RINSED (Y N) METHOD <br /> /nSe RI SE AMU NT <br /> I 1. v,1 <br /> N RINSATE DISPOSAL SITE 17 <br /> S <br /> E MANIFEST # -OR- OTFkR _ <br /> V VAPORS PURGED (Y N) METHOD t <br /> R AMOUNT USED O <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C / ! a <br /> / 0 TANK CONDITION (G00 , F'OOR HOLES) YlA <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> DEXCAVATION SIZE: X X <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P i ' <br /> E I E <br /> C N v <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. w. FT SAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: OW SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />