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PHS-EHD - -UNDERGR JD TANK CLOSURE/ABANDONMENe INSPECTION <br /> (SHADED AREA TO"2rE FILLED IN FOR THE FIRST TANK ONLY) <br /> 'Ay A TWA <br /> OWNER NAME s <br /> E csr rn� r` OWNER PHONE # <br /> E • � CONTRACTOR �` <br /> d CON. PHONE# <br /> SJLHD�,PERMIT # <br /> EPA # <br /> FIRE PERMIT <br /> INSPECTOR C "L DATE j <br /> � <br /> C TANK # 39 <br /> R RINSED /N) METHOD <br /> I 7RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED METHOD <br /> A AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE <br /> 0 <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> < 0 TANK CONDITION I (GOOD, : OOR I N , OLES) <br /> S F' # T <br /> IPE MATERIAL TEEL FIBERGLASS, OTHER) FEE <br /> I T <br /> I PIPING CONDITION (GOOD, 0 R, HOLES) <br /> IJ <br /> + 1' DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X <br /> S --- — X -Z_ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P L • / <br /> EI E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS Of= SOIL <br /> O H DEPTH TO G. W, : FT <br /> N SAMPLING METHOD / <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: (111 4 p SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />