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i <br /> PHS—EHD — UNDE' --MOUND TANK CLOSUREIABANDO ANT INSPECTION <br /> (SHADED AREA O BE FILLED IN FOR THE F 11. a' TANK ONLY) <br /> I <br /> OWNER NAMEl� J OWNER PHONE # <br /> t <br /> Er., G�r [ , <br /> N CONTRACTOR � CON PHONE# X07_?R _, a' <br /> E `� <br /> R 1'le,. 5J'LHD PERMIT # EF'A # FIRE PERMIT # ``!y't /IV/, <br /> c - �k <br /> A l ! f SLl1 J }o'f r.•tl ter frn,t jS <br /> L <br /> INSPECTOR ' " DATE --rf�t � TANK # 31) <br /> R RINSED {Y N) METHODrc RINSE AMOUNT <br /> I � <br /> N RINSATE DISPOSAL SITE <br /> S f' <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED (Y N) METHOD/ •— AMOUNT USED <br /> A ( '00 � <br /> P L. E. L. READING AT REMOVAL (MUST BE { 0%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MA'T'ERIAL (STEE FIBERGLASS, OTHER} TANI', SIZE <br /> K C <br /> ! O TANK CONDITION (GOOD, POOR, HOLES) -{ f� <br /> N <br /> S F'IF'E MATERIAL STE , FIBERGLASS, OTHER) # FEET G vc> t <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) �;r <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: #-S X j 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 <br /> C N <br /> T G TRENCH DIMENSION X -- X YDS OF SOIL <br /> I <br /> OH DEPTH TO Ge WB : _ FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY. SAMPLERS NAME: <br /> L—J CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br /> I <br />