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(�- � c <br /> PHS-EHD - UNDE&OUND TANK CLOSURE/ABANDO*NT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 21 <br /> toe <br /> E2V� UUPV LvTEW, o C2 <br /> E OWNER NAME Z c �� _ OWNER PH NE #"O <br /> N CONTRALTO j7LI; C NS% LGN. PHONE# / 36/•J- <br /> E c17g <br /> R SJLHD PERMIT # FIRE PERMIT # <br /> A / <br /> L <br /> INSPI CTO DC, - TANK # 39 <br /> R RINSED 01N) METHOD RINSE AMOUNT <br /> I v <br /> N RINSATE DISPOSAL SITE J-��5 <br /> S <br /> E MANIFEST # _-_ -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> R AMOUNT USED L; <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S F'IF'E MATERIRL (STEED, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N - C <br /> E K <br /> L <br /> 0S EXCAVATION SIZE: X 3/� X YDS OF SOIL: gG f <br /> I R 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 /> SAMP <br /> 0 H DEPTH TO G. W. FT LING METHODN - ------ <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: �_` 1SAMPLERS NAME: <br /> %o <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />