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r, d a'c <br /> PHS-EHD - UNDERGLdID TANK CLOSURE/ABANDONM 1 <br /> (SHADED AREA TCrBE FILLED IN FOR THE FIRST ANKSONLY)ON <br /> � <br /> E OWNER NAME A/ ox � <br /> .�ls OWNER PHONE # <br /> Zo <br /> E CONTRAOCON. P <br /> TOR / <br /> R SJLHD o HONE# 7�b""37 "7� 9. <br /> PERMIT # EPA # <br /> A FIRE PERMIT # �Z, 'lI: LOs <br /> L <br /> INSPECTOR DATE TANK # 39 - <br /> R RINSED N) METHOD <br /> -/Z.-/Z. yl RINSE AMOUNT w0 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> Moll <br /> V VAPORS PURGED N) METHOD <br /> A X12, �" 17!7 AMOUNT USED ../440 <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 Zr' . . .. <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C Zj <br /> / 0 TANK CONDITION LGOOD�', POOR, HOLES) <br /> N ® <br /> _ S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) .: <br /> P T # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) ' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> F <br /> T : SAMPLE.. : <br /> F A <br /> -I DU/h CU 0 /✓0 d D <br /> E K <br /> L <br /> DF <br /> SIZE: X <br /> EXCAVATION X YDS OF SOIL(:. <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH D I MENS I ON ,__,_ X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT <br /> N SAMPLING METHOD <br /> 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLES <br /> LABORATORY: SAMPLERS NAMES rr`N. YL« <br /> �h04s <br /> CLOSURE IN PLACE MIX URE: VOLUMES <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />