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PHS—EHD — UNDERAUND TANK CLOSURE/ABANDONMW INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />o <br />OWNER. NAME OWNER PHONE # <br />N CONTRACTOR CON. PHONE# <br />L C) <br />CAA"20 4z <br />METHOD qSE AMOUR <br />R RINSED 6"1 <br />N RINSATE DISPOSAL SITE <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGED OY N) METHOD AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST B� ( 20%) <br />N TANK MATERIAL (STEEL, FIBERGLASS, OTH ZE <br />0 TANK CONDITION (GOOD, POOR, HOLES) <br />A; S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />G DEPTH SOIL TYPE OBSERVATION <br />I A DEPTH SOIL TYPE OBSERVATION <br />I YDS OF SOIL <br />0 # OF HOURS SINCE DEWATERING: <br />0 0 HER SAMPLE: <br />61, SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: VOLUME: <br />EH 23043 (10/89) <br />DRAW SITE MAP ON REVERSE <br />