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PHS-EHD - UNDERG. _�,,O TANK CLOSURE/ABANDONML.41--se NSF'ECI*ION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> Lo <br /> OWNER NAME OWNER PHONE # <br /> E ,� <br /> N CONTRACTOR C CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR DATE 3 O TANK # S9 �-- <br /> R RINSED (Y N) METHOD RINSE AMOUNT 0 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD AMOUNT USED o2 Q <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2'0% <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL T , FIBERGLASS, OTHER) TANK SIZE SS Q <br /> K C <br /> / 0 TANK CONDITION POOR, HOLES) UjS; <br /> N OD J <br /> 1 S F'IF'E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N <br /> E <br /> L K <br /> I <br /> D EXCAVATION SIZE: 12- 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 /> 0 H DEPTH TO G. W. : ES-AMPLINIG N 2 METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O =OTHERAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> 7H 230 +3 (10/891 DRAW SITE MAP ON REVERSE <br />