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PHS EH — UNDE,`-�ROUND TANK CLOSURE/ABAt-4-'n* ANT INSPECTION <br /> (SHADED Ar 3 BE FILLEDIN FOR THE Nwer r TANK ONLY) <br /> PIPE", <br /> OWNER <br /> NAME OWNER PHONE <br /> CONTRACTOR CON.. PHOS <br /> E <br /> SJLHD PIE RMI FIRE PERMIT <br /> ,r w .:; x ✓ <br /> INSPE ABY 31 <br /> r RINSE AMOUNT <br /> L_ <br /> RINSATE DISPOSAL SITE <br /> All 4It/14 <br /> E MANIFEST OTHER ; <br /> V VAPORS PURGED Y N]l METHOD AMOUNT USE <br /> A t " <br /> L. E. L. READING AT REMOVAL (MUST BE 20%) <br /> T i LR COMMENTS <br /> TANK MATERIAL <2:EEL I F:rSERGLASS, OTHER) TANK I <br /> aa TANK TIOtt Q� POOR, HOLES) <br /> ) <br /> A ' ; <br /> I <br /> PIPING CONDIT I (GOOD, POOR, HOLES) <br /> # , <br /> t DEPTH SOIL TYPE OBSERVATION <br /> SAM LE # � <br /> i <br /> F ' <br /> I 1 <br /> LL <br /> EXCAVATION SIZES X X la YDS OF SOIL: <br /> I SOIL TY <br /> OBSERVATIONSAMPLE <br /> � <br /> 's <br /> N M <br /> S A I } <br /> p L A <br /> p E I E <br /> IC N <br /> T s TR DS OF SOIL <br /> I <br /> a H DE � "C) �, 1 � t 'tKK. NO METHOD <br /> N <br /> a # OF HOURSINCE DEWATERING: <br /> I <br /> E <br /> OTHER SAMPLE: <br /> E <br /> LABORATORY: SAMPLERS E NAME <br /> I <br /> EH 231043 ( 10/89)) DRAW SITE MAA ON REVERSE <br />