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( <br /> 1� <br /> U, <br /> �r- .Sot l .v�a.�,� ..- t � A.. t toev-,, <br /> f� S ut <br /> PHS-EHD - UNDERG�;6ND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> el <br /> E OWNER NAME <N� Lo OWNER PHONE # <br /> N CONTRACTOR'�''J/ �� � <br /> E /� CON. PHONE# � <br /> T <br /> R SJLHD PERMIT #A . FIRE PERMIT # <br /> L <br /> INSPE T <br /> DATETANK # 39 <br /> R RINSED (Y N) METHOD 5y'-IP �" RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y/ ) 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 FIBERGLASS, OTHER) TANK SIZE Q <br /> K C <br /> / 0 TANK CONDITION (GOOD) POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEE IBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N 11A <br /> G DEPTH SOIL TYPE 09SERVATION AMPLE # <br /> T <br /> JLP- <br /> F A y b vr r <br /> C <br /> I N . <br /> E K <br /> L <br /> D EXCAVATION SIZE: '!�o X l02 X YDS OF SOIL: Q/S <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAJf <br /> MPLE # <br /> N M P <br /> S P I <br /> P L P <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 /> U # OF HOURS SINCE DEWATERING: <br /> 0OTHER SAMPLE: ,� D t LA C F <br /> LABORATORY: SAMPLERS NAME• <br /> 7"i��/<- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAIC ON REVERSE <br />