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PHS-EHD - UNDEFOOUND TANK CLOSURE/ABANDONI&T INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />W, IfA Mj 9, rf&ffl Mffifflllfw <br />.741 &C , W, _pmmm� <br />E OWNER NAME OWNER PHONE # <br />N CONTRACTOR CON. PHONE# <br />E <br />R SJLHD PERMIT # EPA # FIRE PERMIT # <br />L <br />INSPECTOR DATE TANK # 39 - <br />i 19 R a s a p <br />R RINSED &N)0 <br />METHOD RINSE AMOUNT- <br />6L�_e iO_(25 <br />N RINSATE DISPOSAL SITE V <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGEDvy N) METHOD�La AMOUNT USED <br />A I I cle-1 I <br />P L.E.L. READING AT REMOVAL (MUST Bd ( 20%)al <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />K C I <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 />bA6 U-41 <br />G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F A �n CA rA ia A" <br />I N �ly — MIA <br />E K <br />L <br />D S EXCAVATION SIZE: q.1) x YDS OF SOIL: <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 --J <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 />O]l OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE] <br />VOLUME: <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />