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I . <br /> PHS-EHD -- UNDERGRL.(D TANK CLOSURE/ABANDONMEN-- SPECTION <br /> (SHADED AREA TO BE- FILLED IN FOR THE <br /> FF I RST TANK ONLY) <br /> airy r NP E----- <br /> f <br /> uiir� ru liir u it r a ��"7viu"7i rr rr r r u�ir r u v <br /> 4. <br /> f OWNER NAME OWNER PHONE # " <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE -PERMIT # # <br /> A r r r r <br /> L <br /> INSPECTOR y DATE [f (� I TANK # 39. - /17 <br /> R RINSED ON) METHODro(,,,l e plNSC RINSE AMOUNT fz <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD Day AMOUNT USED fS <br /> 1 A `"`'"`���r a <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2O%) <br /> o <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAtST I FIBERGLASS, OTHER) TANF'. SIZE ryL� <br /> E K C <br /> / 0 TANK CONDITION (GOOD, OO , HOLES) <br /> S PIPE MATERIAL (5��, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I P'IP'ING CONDITION (GOOD,..,-POOR; HOLES) <br /> N <br /> G DEPTH SOIL TYPE gSERVATION SAMPLE # <br /> T <br /> F A 7 i Loll., D i� a /D p-ZP2-s L,• <br /> I N � .• �� �P;PZ -B <br /> E K <br /> L, <br /> D EXCAVATION SIZE: X X YDS- OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <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 <br /> I <br /> t O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> L—LABORATORY: SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> .H 2 ,043 ( lo/89) DRAW SITE MAP ON REVERSE <br />