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s � <br /> PHS—EHD — UNDEOOUND TANK, CLOSURE/ABANDOSNT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME OWNER PHONE # ` <br /> E �f �or� f✓iwE� `Y _JUS _� 7�y <br /> N CONTRACTOR <br /> E - ,.�/' - CON. PHONE# <br /> R SJLH PERMIT # <br /> A EF'A # FIRE PERMIT <br /> INSPECTOR DATE <br /> .0 51211 TANK. # 39 <br /> R RINSED YON) METHOD �, �� —�— �•�— <br /> �, RINSE AM(]UNT�/4� G <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED (Y. METHOD -Items <br /> A nvicessC�--f AMOUNT USED N� <br /> P. L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (S/"EE FIBERGLASS, OTHER) TANK, SIZE <br /> K C ' _ X'JV07t <br /> / 0 TANK. CONDITION (GOOD, POOR, <br /> N <br /> S PIPE MATERIAL ( EL ) F <br /> P T ,, IBERGLASS9 OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T _ SAMPLE # <br /> F q <br /> IN <br /> E K %G <br /> L <br /> D EXCAVATION SIZE: <br /> S - Zl— X /� X �' YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE <br /> S P I <br /> P L F. <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL / 3 <br /> / ye,i <br /> 0N 21 <br /> H DEPTH TO G. W. FT SAMPLING METHOD n <br /> Cl # OF HOURS SINCE DEWATERING; <br /> U OTHER SAMPLE: <br /> LABORATORY: ,� .� >` SAMFIL RS NAME: <br /> CLOSURE IN PLACE MIXTURE'. <br /> � VOLUME: <br /> 7H 23043 ( it)/H9) DRAW SITE MAP ON REVERSE <br />