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PHS—EHD — UNDER4VND TANK CLOSURE/ABANDONr INSPECTION <br /> k (SHADED AREA BE FILLED IN FOR THE FIR , TANK ONLY) <br /> E OWNER- NA <br /> M E75- f OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> h�0 <br /> L <br /> INSPECTOR DATE �!' 3-0 Qr' TANK # 39 <br /> R RINSED N) METHOD RINSE AM UNT <br /> I 'f �L <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # " —OR— OTHER <br /> V VAPORS PURGED (Y N)' METHOD AMOUNT USED <br /> A ';--5 <br /> P . L. E. L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> I <br /> T R ' COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C 2 :i. <br /> / O TANK CONDITION (GOOD, PO HOLES)� �� S f�.11✓� a B <br /> N A s <br /> x S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # 4 <br /> T <br /> F A <br /> I N <br /> E K <br /> L " <br /> D S EXCAVATION SIZE- X f3 X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE . OBSERVATION SAMPLE # <br /> N Me 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 /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: j <br /> LABORATORY: 0 A SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />