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PHS-EHD - UNDERf rjND TANK CLOSURE / ABANDONM I f INSPECTION <br /> ( SHADED AREA .i BE FILLED IN FOR THE FIRS 'TANK ONLY ) <br /> OWNER NAME /� OWNER PHONE # <br /> E hCJ �PrLisfv. �c ° f - 5 37 - -7 <br /> N CONTRACTOR CON . PHONE # <br /> E <br /> R SJLHD P RMIT # EF' R # �oouy �j, FIRE PERMIT # � ,7yj� <br /> INSPECTOR �J c_ Ell <br /> TE //// y /f TANK # 39 <br /> R RINSED /�I ) METHOD RINSE AMOUNT <br /> I frr '/F S� er �, C �r <br /> N RINSATE DISPOSAL SITEA4-S ' <br /> jl <br /> E MANIFEST # - OR - OTHER <br /> V VAPORS PURGED 7'N ) METHOD G(`y. ! � � AMOUNT USED 00 <br /> 145 <br /> P L . E . L . READING AT REMOVAL ( MUST BE ( 20% ) L !O c?o <br /> 0 <br /> T R COMMENTS <br /> R <br /> N TANK MATERIAL STEEL FIBERGLASS , OTHER ) TANK SIZE <br /> K C SO O© <br /> / 0 TANK CONDITION ( GOOD POOR , HOLES ) <br /> N <br /> S PIPE MATERIAL S 'TEE FIBERGLASS , OTHER ) # FEET <br /> P T 7lOD <br /> I PIPING CONDITION ( GOOD , OOR HOLES ) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A Or r i.. o%n,� ,d vnlR^ ' C n/ <br /> E K <br /> L <br /> D EXCAVATION SIZE : X X YDS OF SOIL : <br /> S <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 X X YDS OF SOIL 100 61 -3 <br /> 0 H DEPTH TO B . W . __ FT SAMPLING METHOD <br /> N <br /> U # OF HOURS SINCE DEWATERING : <br /> O ❑THER SAMPLE : <br /> LABORATORY : <br /> r ate [? IGS SAMPLERS NAME : M2dP ka rT <br /> CLOSURE IN PLACE MIXTURE : VOLUME : <br /> EH 23042 ( 10 / 89 ) DRAW SITE MAP ON REVERSE <br />