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m � <br />PHS-EHD - UNDERGAD TANK CLOSURE/ABANDONMEM�N�INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />OWNER NAME <br />OWNER PHONE # <br />N <br />CONTRACTOR <br />CON. PHONE# <br />A. <br />V111MAWMAM"M <br />INSPECTOR DATE TANK # 39 <br />R <br />RINSED OYN)' _FMETHOD <br />RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />N <br />MANIFEST # -OR- OTHER <br />Em <br />V <br />VAPORS PURGED (Y/N) T—METHOD <br />AMOUNT USED( - <br />p <br />L.E.L. READING AT REMOVAL (MUST BE <br />COMMENTS 14, <br />T <br />R <br />N <br />K <br />C <br />TANK MATERIAL � �'TSE-L, FIBERGLASS, OTHE TT <br />FINK SIZE <br />clo <br />77-,77- <br />TANK CONDITION (GOOD, POOR HOLES�) <br />0 <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) T# FEET <br />S <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />I <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />I <br />A <br />0 <br />DEPTH TO G. W. FT <br />SAMPLING METHOD Jftl" <br /># OF HOURS SINCE DEWATERING: ZLA <br />F] 0 <br />OTHER SAMPLE:4�(� <br />L11 <br />LABORATORY: 6f ev, <br />SAMPLERS NAME: Le_-,ke__� <br />IL -JE <br />CLOSURE IN PLACE MIXTURE: �jj yV LUME: <br />T VO <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />