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i <br /> PHS-EHD - UNDERq' UAmo4TANK CLOSURE/ABANDON 4T �ECTION <br /> (SHADED AREA Tu BE FILLED IN FOR THE FIRST TANK ONLY) <br /> E OWNER NAME 7OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # <br /> L <br /> INSPECTORI?. N DATE TANK # 39 <br /> RF <br /> ( N) METHOD <br /> I �� & R I NSE AMOUNTc <br /> N DISPOSAL SITE <br /> S 0;/ <br /> E 1 MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED( (Y N) METHOD <br /> A ce AMOUNT USED x r <br /> P L.-E.L. READING AT REMOVAL (MUST BE ( SOX) <br /> 0 r�r <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL T , FI <br /> S9ERGLASS, OTHER) TANK SIZ <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS <br /> P T , OTHER) # FEET <br /> I PIPING CONDITION (GOOD <br /> N , POOR, HOLES) <br /> 6 DEPTH SOIL. TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S ... X J ... X YDS OF SOIL: Jtado <br /> I A DEPTH so m TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T 6 TRENCH DIMENSION X X <br /> I .YDS OF SOIL <br /> O H DEPTH TO S.W. : FT <br /> N 2 SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME; <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> 1 23043 (10/89) DRAW SITE MAP ON REVERSE <br />