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`PHS-EHD - UNDERGlqND TANK CLOSURE/ABANDONMA INSPECTION <br />(SHADED AREA To BE FILLED IN FOR THE FIRST TANK ONLY) <br />........... <br />Cm) 0.Kc-WZ",14,) L_lTY_-7- <br />OWNER -NAME <br />E OWNER PHONE # <br />N CONTRACTOR <br />E Z 115 Nv._:�z co CON. PHONE# <br />R �lSJLHD ERMIT EPA FIRE PERMIT # <br />INSPECTOR DATE TANK # 379 <br />R RINSED Y N),-j(j THOD <br />I &L C,,</, RINSE AMOUNT 19h()n <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST -OR- <br />OTHER <br />V VAPORS PURGED (Y N) METHOD <br />A AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) (-�ojn <br />0 <br />T <br />R COMMENTS <br />A <br />N <br />K <br />TANK MATERIAL STEE I F ,RGLASS, OTHER) TANK SIZE <br />C <br />0 TANK CONDITION (GOOD, POOR, HOLES) 6)'f:, CQ p_ <br />N........... <br />P <br />S PIPE MATERIAL (STEEL, IBERGLAS # <br />T FEET <br />I <br />N <br />PIPING CONDITION (-UUD POOR, HOLES) <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />D <br />S EXCAVATION SIZE: X X YDS OF SOIL :3; <br />I <br />N <br />Iq <br />A DEPTH SOIL TYPE OBSERVATION <br />M p <br />SAMPLE # <br />S <br />P I <br />P <br />L P <br />E <br />CN <br />I E N)o <br />......... ......... <br />T <br />I <br />G TRENCH DIMENSION X XYDS OF SOIL <br />0 <br />N <br />I , '�yo <br />HDEPTH TO G. W.' FT w <br />2 SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />H 22043 (10/89) DRAW SITE MAP ON REVERSE <br />