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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> is//!.//fM <br /> ro at_3iQTfr?T= <br /> OWNER NAME OWNER PHONE <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTORATE S-1 q 39:o ?3 TANK * <br /> IR RINSED2N) METHOD RINSE AMOUNT <br /> j <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED %N) METHOD AMOUNT USED <br /> A Lz�� I <br /> P L. E. L. READING AT REMOVAL (MUST Bf ( -20%) <br /> T 2 R COMMENTS <br /> A <br /> N TANK MATERIAL<FEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> a TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> j. S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET <br /> PT E <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> F 1; <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X 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 <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 a <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 1 OTHER <br /> SAMPLE: <br /> =2=LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> :-H 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />