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F__ <br /> PHS-EHD -- UNDER G ND TANK CLOSURE/ABANDONMEI INSPECON <br /> (SHADED AREA rTT/O p�BE ,yFILLED IN FOR THE FIRST TANNxK ONLY) <br /> S # i <br /> U�l��ZYi <br /> E <br /> OWNERNAME OWNER PHONE # <br /> X39' -a-7/ <br /> N CONTRACTOR CON. PHONE# <br /> E " ��► f a� 3-5- <br /> R SJLHD PERMIT # EPA # FIRE PER ## <br /> A <br /> L .r r <br /> INSPECTOR C+i Ce- DATE ///��/�� TANK # 39 <br /> R RINSED ON) <br /> METHOD RINSE AMOAJ <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S - ��rp/e cr s <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE ( �bX) <br /> D 9 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TE , FIBERGLASS, OTHER) TANY, SIZE <br /> K C /0 000 <br /> / O TANK CONDITION OD POOR, HOLES) <br /> N <br /> S PIPE MATERIA ISTEE <br /> P T FIBERGLASS, OTHER) # FEET �. <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYRE OBSERVATION <br /> T SAMPLE # <br /> F A r d r <br /> I N Si!! Al <br /> fr S <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X _�Oz X �� YDS OF SOIL: <br /> N M <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # ' <br /> P <br /> S P I e <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I i <br /> © H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 - <br /> BjZc-SS 4&�Nr <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME- <br /> CLOSURE <br /> AME;CLOSURE IN PLACE MIXTURE: VOLUME: <br />`.EH 22043 ( 14/ 39) DRAW SITE MAP ON REVERSE <br />