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PHS-EHD - UNDERIJUND TANK. CLOSURE/ABANDON*- INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> "l�"1"y"y"'/"ru"y"y,"Y"l""Yml <br /> /� S, <br /> OWNER NAME LC ph ) M S !7/ 1 OWNER PHONE # �a0 <br /> E � 1 t <br /> E CONTRACTOR SL-:MC'O CON. PHONE# aDC� ��/e_��53 <br /> " r 77 k <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # i { <br /> L <br /> INSPECTORd DATE TANY. # C9 <br /> R RINSED ON) METHOD RINSE 0 N <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED , (Y�N) METHOD AMOUNT USED <br /> R ` ) <br /> P L. E. L. READING AT REMOVAL (MUST BEJ ( 20%) E L D <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (5TEE , FIBERGLASS, OTHER) TANK. SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, OOR, HOLES) <br /> N <br /> `r S F'IF'E MATERIAL STEE FIBERGLASS, OTHER) # FEE"f <br /> P T <br /> I PIPING CONDITION (GOOD(;:POOR HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A v� sib <br /> I N <br /> E K <br /> Li <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 n <br /> E I EAlt <br /> C N Hea <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I — <br /> 0 H DEPTH TO G. �Uo7 FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑0 OTHER SAMPLE: <br /> LABORATORY: �Q Q �Z SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> .H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />