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PHS-EHD - UNDERGROL TANK CLOSURE/ABANDONMENT _NSPECTION , <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 0 Lff),rigN TANA <br /> ITIM! <br /> E ,f OWNER NAME CG + ttd OWNER PHONE <br /> E CONTRACRLj (� we CON. PHONE# q �/ <br /> PERMIT # AZ7776 <br /> A FIRE PERMIT <br /> / (/ / <br /> • J <br /> INSPECT DATE <br /> � �-�6 TANK # .:,9 <br /> R R I NSD E /� <br /> I METHOD RINSE AMOUN"f <br /> N RINSATE DISPOSAL SITE <br /> S r <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD� �Y <br /> A AMOUNT USED Ib b <br /> 0 L. E. L. READING AT REMOVAL (MUST BE ( 2C)%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD POOR, HOLE _N _Ole e 3 ooti `p <br /> • S PIPE MATERIAL (ST - L, IBERGLAS , O•fHER) # FEEf <br /> P T <br /> I PIPING CONDITION (GOOD FLOOR, HOLES) <br /> N �� G <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. ; <br /> N - FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br />•H 230k3 ( 10/89) DRAW SITE MAP ON REVERSE <br />