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T <br />A <br />N <br />K <br />A. <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />N <br />S <br />P <br />E <br />C <br />PHS-EHD OUND TANK CLOSURE/ABANDON&T INSPECTION <br />(SHADEDAREA 1 . FILLED IN O. <br />THE FIRST TANK ONLY) <br />OWNER NAME <br />OWNER PHONE #i <br />-` •- <br />CON. PHONE# <br />SJLHD r <br />INSPECTOR-CCvwa DATETANK # 39 - <br />R RINSED /N) METHOD <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />I D - <br />RINSE AMOUNT <br />O- OTHER <br />RS PURGED(��) METHOD <br />�u AMOUNT rI 51A <br />P L. E. L. READING AT REMOVAL ( MUST Be( 20X ) <br />O <br />R COMMENTS <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />C <br />N TANK CONDITION GOOD POOR, HOLES) <br />�c <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />T DEPTH SOIL TYPE OBSERVATION <br />A <br />N G <br />K S <br />EXCAVATION SIZE: X X <br />S _ <br />A DEPTH SOIL TYPE. OBSERVATION <br />M P <br />P I <br />L P <br />I E <br />N <br />TANK SIZE <br /># FEET <br />YDS OF SOIL: <br />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 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />SAMPLE # <br />SAMPLE # <br />m <br />