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PHS-EHD - UNDEPOOUND TANK CLOSURE/ADANDO*INT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME <br /> / OWNER PHONE #/ O� <br /> N CONTRACTOR !/ <br /> E S � � � o <br /> CON. PHONfw# 61 �(� <br /> R SJLHD PERMIT # EPA # <br /> �j'' p,� U�� FIRE PERMIT # � <br /> INSPECTORLe Y7* I S S %k <br /> DATE �' I Q 7 n TANK <br /> f� <br /> - �1 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED (Y/N) MET p <br /> A AMOUNT USED <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> N TANK MATERIAL (STEEL, FIDERGLASS, <br /> K C OTHER) TANK SIZE <br /> / 0 TANK CONDITION (GD <br /> POOR, <br /> N , HOLES) <br /> A S PIPE MATERIAL (S EEL, FIBERGLASS, D"THER) # FEET <br /> T <br /> I PIPING CONDITI N (GOOD, <br /> N PDDR, HOLES) <br /> G DEPTH SOIL TYPE <br /> TOBSERVATION <br /> SAMPLE # <br /> F A <br /> I <br /> E K <br /> L 4e <br /> D EXCAVATION SIZE: <br /> S X X YDS Df= SD I L: <br /> I A DEPTH SOIL TYPE � <br /> N M �, OBSERVATION <br /> SAMPLE # <br /> S P I - <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS Of: SOIL <br /> 0 H DEPTH TO G. W. : <br /> N -------, FT SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: C4 0us SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> V OL U!~IE <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />