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1 J <br /> I <br /> PHS-EHD -- UNDER'.'^ )UND TANK CLOSURE/ABANDONIJ,#T INSPECTION <br /> . <br /> (SHADED AREA BE FILLED IN FOR THE FIRST TANK ONLY) <br /> EOWNER. NAM ' <br /> OWNER PHONEr# <br /> N CONTRACTOR ji CON, PHONE# <br /> R ?-05 -- q3 7-- • f 0 <br /> R SJLHD PERMIT # EGA # <br /> A • FIRE PERMIT # <br /> L <br /> INSPECTOR; S L� DATE - L�r� <br /> r <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMO NT <br /> N RINSATE DISPOSAL SITE <br /> S . <br /> E'! MANIFEST # -OR- OTHER <br /> :r <br /> V ' VAPORS PURGED (Y/N) TMETHOD A . AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < EGG) <br /> O <br /> T R COMMENTS <br /> A <br /> N C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K <br /> / O iTANK CONDITION (GOOD, POOR, HOLES) <br /> N ' <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE'S <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION S C SAMPLE # <br /> T <br /> F i A �l <br /> I N y D <br /> E K ,d <br /> L fou . <br /> D S EXCAVATION SIZE: X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OLSERVATION 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. : FT SAMPLING METHOD <br /> N 2 <br /> 4 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> ORATORY: i �(�c � �c{.� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH ~37043 :( 14/89) DRAW SITE MAP ON REVERSE <br />