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PHS—EHD — UNDERGR( D TANK, CLOSURE/ABANDONMEN�INSF'ECTION <br /> (SHADED AREA TO ifE FILLED IN FOR THE FIRST TT'/ANN'/K ONLY) <br /> '�zw - / <br /> OWNER NAME � OWNER PHONE # Ire, <br /> E <br /> N CONTRACTOR ` CON. PHONE# <br /> E � �oh3 / <br /> R SJL HD PERMIT # EPA # FIRE PERMIT # w <br /> A <br /> L <br /> INSPECTOR DATE 9-may-y TANK # - <br /> FR RINSED (Y/N) METHOD RINSE AM�ES NT44. i Y <br /> I , <br /> N RINSATE DISPOSAL SITE eQ� 7 cT; - '17 <br /> S <br /> E MANIFEST # _ -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD ice AMOUNT USED /s <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST RE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE S C� 7cc l <br /> K C `- <br /> / 0 TANK CONDITION (GOOD, 00 HOLES) <br /> N �- <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) it FEET <br /> Pi T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE : _ X _7 ' X ] YDS OF SOIL: 7c'D <br /> S <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_ Y�� <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> C # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: c/ue /r/c <br /> �c� �h z SAMPLERS NAME: �u✓F �c( n,, <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> FIi 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />