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PHS-EHD - UNDERG' D TANK CLOSURE/ABANDONME i INSPECTION <br /> (SHADED AREA T&4A FILLED IN FOR THE FIRST NK ONLY) <br /> YAW <br /> E OWNER NAME OWNER PHONE # <br /> a <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A. <br /> L <br /> INSPECTOR C. DATE -79# 39 <br /> Y .zz�z <br /> R RINSED �N) METHOD <br /> I ?s� RINSE AMOUNT 300 <br /> S�C!/ZG <br /> N RINSATE DISPOSAL SITE Y <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED <Y N) METHOD �� AMOUNT USED„ <br /> A �y0 /d s <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE FIBERGLASS, OTHER) TANK SIZE <br /> K c /..Z OOL I>�P <br /> / 0 TANK CONDITION (:(GOOD POOR, HOLES) <br /> N <br /> +' S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> FZOV0 co 0 o�v <br /> I N r� aq�cr s/n if Isco 6 iov a <br /> E K isle% .J G <br /> L <br /> D EXCAVATION SIZE: L_ X %2_ X YDS OF SOIL: i- <br /> S /oil 7S c/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 <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : FT <br /> N 2 SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: /4/00rf- (aG (�(,�o/s �{ SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />