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PHS-EHD - UNDERGRUE'. TANK CLOSURE/ABANDONMEN . '-'NSPECTION <br /> (SHADED AREA TO FILLED IN FOR THE FIRST TN,4k ONLY) <br /> a r r orirrrniv�'�iri.Uiiri� r riviur u��rr . �ri � rr ri r� a u r a .v r rr ri r,v <br /> OWNER NAME OWNER PHONE # <br /> i <br /> E <br /> j N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br />� L <br /> INSPECTOR DATE (7 �( TANK # 39 <br /> R RINSED YON) METHOD f r'G 6Q-1� - RINSE AMOUNT z <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> R L. E. L. READING AT REMOVAL (MUST BE < 20X) .. ; ' = L 7= C1•� <br /> 0 <br /> T R COMMENTS <br /> A _ _ <br /> N TANK MATERIA STEE FIBERGLASS, OTHER) FTANK SIZE <br /> K C <br /> l / O TANK. CONDITION (GOOD', O HOLES) <br /> N <br /> S FIRE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> k P T <br /> I PIPING CONDITION (GOOD - <br /> GOOD,--'-PtO R, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N <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 /> O H DEPTH TO G. W. FT SAMPLING METHOD � <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: i <br /> (k LABORATORY: SAMPLERS NAME: <br /> L 11 L -- -- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> I - <br /> {: EH 230.43 ( I0/99) DRAW SITE MAP ON REVERSE <br />