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PHS—EHD — UNDERGIND TANK CLOSURE/ABANDONM�_.-s' INSPECTION,- <br /> (SHAVED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> a �V � � � ��� <br /> OWNER N �� OWNER PHONE' # <br /> N A CONTRACTOR CON. ! <br /> E PHONE# -� ?J' r �Z <br /> R. SJLHD PERMIT # G A#- � FIRE PERMIT <br /> INSPECT R DATE $ �� TANK <br /> R RINSED (Y N) METRO❑ /� /blSa RINSE AMOUNT f <br /> I <br /> N RINSATE DISPOSAL SITE <br /> s � SSR ✓iC e5 <br /> E MANIFEST # -OR,- OTHER <br /> V VAPORS PURGED Y ) METHOD AMOUNT USED ` <br /> A <br /> P L.E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS " <br /> A <br /> N TANK MATERIALS <br /> TEEL FIBERGLASS, OTHER) TANK SIZE d � <br /> K C <br /> 1 0 TANK CONDITION(( 010D <br /> POOR, HOLES) <br /> N <br /> 4 • S PIPE MATERIAL (STEEL) FIBERGLASS, OTHER) )# FLET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) ` � !!J' � <br /> N /V� /NZA4' T� 7 r <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F Aig <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X LZY �S- O �S- L; <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M R <br /> S P I <br /> P L P <br /> E I E' <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : .� FT SAMPLING METHOD V <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 1N. <br /> 011 <br /> THER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> � G <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/8S) DRAW SITE MAP ON REVERSE. <br />