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1 <br /> PHS--EHD - UNDERbAGUND TANK CLOSURE ABANDONMONT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ZVA <br /> OWNER NAME OWNE PHONE # <br /> E _ �,,L�p� <br /> N CONTRACTOR <br /> �_r" y` CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # - <br /> € L t v r, <br /> INSPECTOR er6"M,0L--'j DATE e-31- rANK # 39 - <br /> R RINSED (Y N) METHOD l RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # - R- OTHER <br /> V VAPORS PURGED aN) METHOD P ( (QC AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST B < 20%) L r j <br /> 0 <br /> i T R COMMENTS <br /> A <br /> N TANK MATERIAL FIBERGLASS, OTHER) TANK SIZE I <br /> � K C .,1 <br /> / 0 TANK CONDITION OD POOR, HOLES) tj0 v-7 19 1 <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> i P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> I N <br /> G i DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> Al <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X J2:. YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P S� <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> i <br /> 0 DTHER SAMPLE: <br /> t LABORATORY: SAMPLERS NAME: �a � <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> :H 2.2',043 ( 10/89) DRAW SITE MAP ON REVERSE <br />