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PHS-EHD - UNDERC-•.1ND TANK CLOSURE/ABANDONM& INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME OWNER F'HONE # <br /> N CONTRACTOR <br /> E <br /> R SJLHD PERMIT # ERA # - <br /> A ' > i FIRE PERMIT it <br /> L <br /> -- J <br /> INSPECTOR 6 DATETANK # 39 - <br /> /-� '� , <br /> R RINSED (Y N> , METHOD <br /> I �_ --' RINSE AMOUNT _ <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (YYN) METHOD <br /> A AMOUNT USED <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 _- <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL �ST�L, FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION (GOOD 'OOR HOLES) <br /> N _�' t- <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 R <br /> I <br /> N <br /> Sihw1 <br /> E K <br /> L <br /> D :EXCAVATION SIZE �j X X <br /> S YDS OF .,OIL: <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 <br /> T G TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W, : FT <br /> N SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: <br /> ,. j:-;'; SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: <br /> ,- VULUhIE: y I;, <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />