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PHS—EHD — UNDER"�OUND TANK CLOSURE/ABANDON, INSPECTION <br /> (SHADED AREA „ BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME ��".���"Y�y�'�d <br /> <, j71 <br /> E a oi� OWNER PHONE # j <br /> i <br /> N CONTRACTOR <br /> E e,C2 CON. PHONE# <br /> R SJLH PERMIT # EGA # <br /> A . FIRE PERMIT # <br /> L �T( , .,,,, ✓,� <br /> J <br /> INSPECTOR <br /> ( � DATE /� /�` p TANK # 39 — /ii <br /> R RINSED (6'/N) METHOD <br /> I - G, ! RINSE AMOUNT v. <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> —OR— OTHER <br /> V VAPORS GORGED Y/N) METHOD <br /> A i C2 16C AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE <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, BOOR HOLES) <br /> N <br /> S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, 00 HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> A/ BANGLE <br /> F # <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: /oJ X /0 <br /> S --- X 7 YDS OF SOIL: <br /> I q ( t � <br /> N M G DEPTH SOIL TYPE OBSERVATION <br /> S GI SAMPLE # <br /> c� Cc c <br /> P L G <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF= SOIL ! <(J <br /> 0 H DEPTH TO G. W. : <br /> N O FT SAMPLING METHOD <br /> C, <br /> # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME 7 <br /> CLOSURE IN PLACE MIXTURE: C/li�� <br /> VOLUME: <br /> ( x'043 ( 10/89) DRAW SITE MAP ON REVERSE <br />