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PHS-EHD - UNDE D TANK CLOSURE/ABANDON <br /> (SHADED AREA I <br /> FILLEDN FOR THE FIRST INSPECI'IOIV <br /> � � TANK ONLY) <br /> ,.� OWNER NAME <br /> OWNER PHONE # <br /> N CONTRACTOR <br /> E / /` r c./ CON. PHONE# <br /> A . SJLHD PERMIT # <br /> EPA # FIRE PERM I T # <br /> INSPECTOR DATE <br /> 90 TANK # <br /> R RINSED (Y/N) METHOD T _ <br /> I brr,¢ RINSE AMOUNT <br /> N R I NSATE DISPOSAL SITE <br /> S <br /> E MANIFEST <br /> -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A AMOUNT USED <br /> 0 L. E. L. READING AT REMOVAL (MUST BE ( 2Ci%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MA"fERIAL (STEEL, FrBERGLASS <br /> K C - , OTHER) TANK SIZE z; <br /> / 0 TANK CONDITION (GOOD, POOR,y HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS <br /> P T , OTHER) # FEES <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> IA <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X S <br /> S YD., <br /> I A DEPTH SOIL TYPE UR..SERVATION <br /> N M P SAMPLE ## <br /> S F' I <br /> P L FI <br /> E I E <br /> C N <br /> T G TRENCH DIMENSIQN <br /> I X --- X YDS OF SOIL <br /> a H DEPTH TO G. W. : <br /> N ? ---- FT SAMPLING METHOD <br /> C) # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> r' SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VCJLUhIf_:: <br /> EH `32°43 ( iu/ee) DRAW SITE MAP ON REVERSE <br />