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PHS-EHD - UNDER( ibhrQD TANK CLOSURE/A9ANDONM: 4--tNSPErTION <br /> (SHADED AREA Tb BE FILLED IN FOR THE FIRST TANK. ONLY) <br /> lum <br /> OWNER NAME ,, OWNER PHONIf # 7 <br /> E S <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD ERMIT # EPA # cN(voov7i? 3 FIRE PERMIT <br /> A <br /> L <br /> INSPECTOR L r �� DATE `��aal//� TANK # .39 - lsa - o <br /> R RINSED ON) METHOD RINSE AMOUNT <br /> I 71 - ::9 64z <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (9/N) FMETHOD �Ge AMOUNT USED <br /> A /d s <br /> P L. E. L. READING AT REMOVAL (MUST BE ( ;0%) 3 _ 0 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL �ELFIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / 0 TANK. CONDITION (GOOD, POOR, H 7 ) <br /> N c <br /> r S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) T# <br /> FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A % /V i <br /> I N S _ d'�s c o Lvr u.L d o <br /> E K ' � <br /> L G S <br /> D EXCAVATION SIZE: 17 �X /5` X --9-� YDS OF SOIL: 5-0Y,v3 <br /> S <br /> I A DEPTH SOIL YPE OB RVATION SAMPLE # <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 FYDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT 7 <br /> SAMPLING METHOD <br /> N <br /> O # OF HOURS SINCE DEWATERING: <br /> ml <br /> OTHER SAMPLE: <br /> LABORATORY: — � e'�q SAMPLERS NAME:sk t o S <br /> CLOSURE IN PLACE MIXTURE: VOLUME: ! <br /> =H 2-3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />