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PHS-EHD -UNDER <br />%UND TANK CLOSURE/ABANDONAT INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />OWNER NAME E OWNER PHONE # <br />N ..CONTRACTOR <br />E CON. PHONE# <br />R SJLHD 'ERMIT # EPAve/i <br />A. FIRE PERMIT # <br />L <br />INSPECTOR DATE Z/W 91 TANK <br />R RINSED (YN) METHOD <br />I RINSE AMOUNT Isno <br />N RINSATE DISPOSAL SITE <br />E MANIFEST # )ni7 77, 1 -OR- OTHER <br />V VAPORS PURGED (Y/N) METHOD <br />A AMOUNT USED <br />p L.E.L. READING AT REMOVAL (MUST BE 20%) 0 <br />0 0 <br />T R COMMENTS <br />A 19; <br />N TANK MATERIAL STEE 9 FIBERGLASS, OTHER) <br />K C TANK S I Z E <br />0 TANK CONDI - TION (GOOD, POOR S) rro6 <br />N <br />A S PIPE MATERIAL (STEEL, BERGLA OTHER) <br />P T ) # FEET <br />I PIPING CONDITION <br />GOODS N mo POOR, HOLES) <br />__(G� <br />G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F A <br />I N <br />E K <br />L <br />D S EXCAVATION SIZE: ZL X � x _LL, YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION C,,q 53� <br />I <br />N m p SAMPLE # <br />S P 1 0 <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X 3, X <br />I YDS OF SOIL S7`ds-3 <br />0 H DEPTH To G.W.: c� <br />N 1 2 FT SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: 'gQJOIA' <br />SAMPLERS NAME: PV\)W)O'kk) J`tS( Uig <br />CLOSURE IN PLACE MIXTURE: VOLUME <br />. 7-H 2.3043 (10/89) DRAW SITE MAP ON REVERSE <br />