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I <br />'PHS-EHD - UNDERGND TANK CLOSURE/ABANDONMA INSPECTION <br />(SHADED AREA To <br />0 <br />BE FILLED IN FOR THE FIRST TANK ONLY) <br />................... <br />E <br />OWNER NAME <br />. UW <br />I <br />OWNER PHONE # <br />N <br />CONTRACTOR <br />E <br />CON. PHONE# <br />R <br />A. <br />.'SJLH PERMIT # <br />EPA # FIRE PERMIT # <br />L <br />Row R <br />-19 - <br />INSPECTOR DATE TANK # "39 <br />R RINSEDH N) METHOD -F,,o <br />, w <br />I � <br />I - 11 12tc <br />RINSE AMOUN <br />N RINSATE DISPOSAL SITE <br />s <br />6 - 6 % <br />E MANIFEST #2LL -OR- OTHER <br />V VAPORS PURGED 'Y <br />A <br />METHOD AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T <br />R COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIAL S EEL,' FIBERGLASS, OTHER) TANK S I Z E <br />cu <br />O TANK CONDITION (GOOD,y S) <br />N <br />P <br />S PIPE MATERIAL (STEEL, FIBERGLAS , OTHER) <br />T 7# FEET <br />N <br />PIPING CONDITIO GOOD, POOR, HOLES) <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />T <br />SAMPLE # <br />F <br />A <br />I <br />N <br />E <br />K <br />(2-7 <br />L <br />C <br />D <br />EXCAVATION SIZE: zy X X YDS <br />S OF SOIL: <br />I <br />N <br />A DEPTH SOIL TYPE OBSERVATION <br />M p <br />SAMPLE <br />S <br />P I <br />P <br />L P <br />E <br />I E <br />C <br />N <br />T I <br />I <br />1 <br />G TRENCH DIMENSION 2' X 2L X YDS OF SOIL <br />0 <br />N <br />H DEPTH TO G. W. FT <br />2 SAMPLING METHOD <br />0 OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: PVOLUME: <br />H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />