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0 <br /> PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 1201132K 11��ll <br /> 12 A IffIl�wmjl <br /> ..L <br /> 6 All, <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> _ <br /> E <br /> R SJLHD PERMIT # C7 EPA # FIRE PERMIT # <br /> L I Lill ul <br /> IN PECTORLDATE TANK 39 <br /> 'of 771 <br /> I R RINSED[ (Y ON) METHODRINSE AmouNl <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGE �'Y/ METHOD AMOUNT USED <br /> A T-0-7 <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE �6 <br /> K C L <br /> 0 TANK CONDITION (GOOD,(=PO0R;) HOLES)O-i"P <br /> Vii: iii N <br /> E 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 /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D ,EEXCAVATION 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 —7— <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO S. W. : FT SAMPLING METHOD <br /> N 2-, <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> ELABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: I VOLUME: <br /> --H 23043T (10/89) DRAW SITE MAP ON REVERSE <br />