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PHS-EHD - UNDER#ND TANK CLOSURE/ABANDONMO INSPECTION <br /> (SHADED AREA TU BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ah <br /> OWNER NAME / OWNER PHONE # <br /> E (_ <br /> N CONTRACTOR S ,An CON. PHONE# <br /> E Y7 L <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L ;, <br /> INSPECTOR 7, IW'sJ,,j DATE `j-D-O'Q/ TANK # 39 - 03 <br /> R RINSED (Y/N) METHOD • RINSE AMOukJr <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD AMOUNT USED �Q <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20;x) J01p � r L 06 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK. SIZE <br /> K 0 TANK CONDITION (GOOD, OR HOLES) (U 0 `/"1 <br /> N <br /> S PIPE MATERIASTEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A - <br /> IK <br /> L <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 <br /> E I E <br /> C N ;;��!�r <br /> T G TRENCH DIMENSION X YDS OF SOIL <br /> I <br /> 0H DEPTH TO G. W. �a_ FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 1) OTHER SAMPLE: <br /> LABORRTORY: G G SAMPLERS NAME:G�, ? <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> .H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />