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PHS-EHD - UNDE OUND TANK CLOSURE/ABANDON T INSPECTION <br />(SHADED AREA `�0 BE FILLED IN FOR THE FIRST TANK ONLY) <br />111 <br />.a <br />C <br />E OWNER NAME i OWNER PHONE # <br />N CONTRACTOR C CON. PHONE# <br />E <br />R SJLHD PERMIT # EPA FIR"PERMIT , <br />A <br />L r <br />INSPECTOR 1 i DATE TANK # 39 <br />R RINSED Y N) METHOD RINSE AMOUNT <br />Y <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # —OR— OTHER <br />AV VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br />0 <br />T R COMMENTS <br />A <br />K C TANK MATERIAL (STEEL, FIBERGLASS, OTHER ) TANK SIZE 1 b ®C» <br />/ 0 TANK CONDITION GOOD POOR, HOLES) <br />N <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F q IR <br />I N p <br />E K <br />L <br />D EXCAVATION SIZES X LID X I 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 ;� <br />G # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />