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} <br /> PHS-EHD - UNDERD TANK CLOSURE/ABANDONt4Ak NSPECTION <br /> (SHADED AREA TA FILLED IN FOR THE FIRST TANK ONLY) <br /> SS <br /> 0A1 14 <br /> OWNER NAME q 3j6 <br /> E `/p C. os OWNER PHONE <br /> E ; CONTRACTOR CON. PHONE# <br /> °j- may- 36 �=6/T7S <br /> A S.TLHD PERMIT # EPA �O( <br /> //{� FIRE PERMIT # T Z <br /> L �' y <br /> �� rl <br /> INSPECTO�y <br /> 2 RINSED /N) METHO •fie /elN3C RINSE AMUUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHOD it <br /> A AMOUNT USED <br /> G L-E. L. READING AT REMOVAL (MUST BE ' ( 20%) -- <br /> 0 <br /> T ' R COMMENTS <br /> A O A-I <br /> N 12 TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C Ood <br /> / ' 0 TANK CONDITION (GOOD, POOR, OLES) /0 <br /> N <br /> S PIPE MATERIAL (STEE <br /> P T , FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DELT SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> E II - K <br /> L <br /> D S EXCAVATION SIZE: � X X 77 : <br /> YDS OF SOIL: �JprS f <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P ``L P <br /> E I E <br /> C IN <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> E <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY-. I.Ii �f - SAMPLERS NAME Ip <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />