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PHS-EHD - UNDERGF•ND TANK CLOSURE/ABANDONMA INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �iam�nw�Hi�€uwayaru�wm�r�ruwruwwwwww wwwi u�v����!aw uruwwiuiuiaraiuiuiur'�yiurr��iuwr�viuw uruvii�w� <br /> OWNER NAME 3 ( OWNER PHONE # J4 <br /> E <br /> N CONTRACTOR ') n C� CON. PHONE# <br /> E <br /> R SJLHD, G�ERMIT # EF'R # FIRE PERMIT # � <br /> MEN <br /> GG ✓ � i � H �- f GCGG <br /> L <br /> � <br /> I <br /> INSPECTO DATE3� 1q I TANK # 39 <br /> R RINSED O/N) METHO � RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20/) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, . IBERGLASS� OTHER) TANK SIZE Ib bQ <br /> K C <br /> / 0 TANK CONDITION60OD POOR, HOLES) <br /> ';'.I ...:., N <br /> ,.,..y.. S PIPE MATERIAL (STEEL, ''FL IBERGLAS , OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G D PTH SOIL TYPE OBSERVATION SAMPLE # <br /> T a <br /> F A � -C) CNsT <br /> I N <br /> E K c SI- <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S I <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I S <br /> i G L G <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. 'W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> I_.' OTHER SAMPLE: <br /> I` LABORATORY: C)Sida � i��( �� 77 SAMPLERS NAME: -E T <br /> CLOSURE IN PLACE MIXTURE: ` VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />