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0 0 <br /> PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> Z3921! 1!11 11!11�1!WAYM1111M <br /> .4 WWI <br /> i i LJ <br /> OWN <br /> E <br /> R <br /> NAME - OWNER PHONE <br /> # <br /> EN CONTRACTOR ` CON. PHONE# <br /> E <br /> R SJLHD PERMIT # E P I A # FIRE PERMIT # <br /> 21 <br /> INSPECTOR DATE8- 2' E3TANK # 39 - <br /> R RINSED N) METHOD <br /> RINSE AMO T <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (2Y N) METHOD4j AMOUNT USED <br /> A I <br /> P L. E. L. READING AT REMOVAL (MUST A -.0%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA : EEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIA �TEM-Lo FIBERGLASS, OTHER) EFEET <br /> P T - <br /> I PIPING CONDITION (GOOD, POOR HOLES) <br /> N v <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T C'd2a–z <br /> az <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF S6fL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N m P <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 /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 I=ER SAMPLE: <br /> LABORATORY: 77 SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> --H 230432 ( 10/89) DRAW SITE MAP ON REVERSE <br />