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PHS--EHO - UNDERGROUp`TANK CLOSURE/ABANDONMENTA%SPECTION <br /> i (SHADED AREA TO Ff ILLED IN FOR THE FIRST TttA ONLY) <br /> OWNER- NAME <br /> E OWNER � PHONE # <br /> N : CONTRACTOR <br /> E 'y CON. PHONE# ; <br /> R SJLHD PERMIT # EFA <br /> i s <br /> # <br /> A• : , „ ` ,, , , ,., , FIRE PERMIT # �� <br /> 3 <br /> INSPECTOR C NS DATE TANK # 39 <br /> R RINSED'ON) 7METHOD I <br /> I RINSE AMOUNT�Soo i <br /> N RINSATE DISPOSAL SITE I+ <br /> S ��T►"�L' ServiCPS � ,pnJ� c A <br /> E MANIFEST # o� <br /> -OR- <br /> OTHER <br /> V VAPORS PURGED {V N) METHOD a <br /> A AMOUNT USED , <br /> G' <br /> P L.-E. L. READING AT REMOVAL (MUSTRE ( 20%) <br /> O <br /> T R COMMENTS <br /> R <br /> TANK MATERIAL. TEE FIBERGLASS, OTHER) TANK SIZE <br />^( C S,.SD <br /> O TANK CONDITION (GOOD, POOR HOLES J <br /> N a/? <br /> S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) # FEET <br /> 3 T C/n/kn�au.�l <br /> PIPING CONDITION (GOOD POOR, HOLES) <br />' DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> A C No Q d*' sco 0 ov d <br /> N ] <br /> K j <br /> EXCAVATION SIZE: X `r X r7 <br /> S .� YDS OF SOIL: <br /> A DEPTH SOIL TYPE. OBSERVATION <br /> M p SAMPLE # ` <br /> P I <br /> L p <br /> N E 1 <br /> G TRENCH DIMENSION X Xi <br /> YDS OF SOIL y <br /> H DEPTH TO FT SAMPLING METHOD i <br /> i <br /> U # OF HOURS SINCE DEWATERING: ! <br /> O OTHER SAMPLE: i <br /> 1 <br /> LABORATORY: UJe f' SAI*IF,LERS NAME: ` <br /> �✓/1r� Drxria.•� <br /> CLOSURE IN PLACE MIXTURE: ,. <br /> VOLUME: <br />'-'•043 ( 10/8,3) DRAW SITE MAP ON .REV.ERSE - <br />