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PHS-EHD - UNDERGND TAN}{ CLOSUREtABAND❑NME INSPECTION <br /> (SHADED AREA T E FILLED IN FOR THE FIRST TANK ONLY) <br /> 114 <br /> oe/ ice <br /> E OWNER NAME G�•� .£,G� OWNER PHONE # <br /> I i <br /> E ! CONTRACTOR �U� �[ f CON. PHONE# 4 <br /> R . SJLHD PERMIT # EPA # 3 o FIRE PERMIT # <br /> �r + i r i f f + i 11 //,�' / + f ` f+ �s <br /> INSPECTOR + � DATE TANK # W9 - fay) -- <br /> R RINSED (Y N) METHOD re RINSE AMOUNT <br /> N RINSATE DISPOSAL SITECtS - <br /> S <br /> E MANIFEST # -❑R- OTHER <br /> V VAPORS PURGED (Y N) METHOD <br /> A I�rL [CP AMOUNT USED <br /> � <br /> P L.E. L. READING AT REMOVAL (MUST DE < 120%) Oa � --°fo LCL <br /> D <br /> T R COMMENTS <br /> A <br /> K C TANK MA'rER I AL NT�c-: , F I ESE RGLASS, OTHER) TANK SIZE <br /> - �t <br /> ❑ TANK CONDITION (GOO- POOR HOLES) �j -�i <br /> N <br /> S PIPE MATERIAL (STEEL,I FIBERGLASS, OTHER) # FEET r <br /> P T � OU IC <br /> I PIPING CONDITIONGDOD POOR, HOLES) fill <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N <br /> E <br /> D EXCAVATION SIZE: X 'X �> YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATIDN SAMPLE # <br /> N M P <br /> S P I c <br /> P L P ' <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL. <br /> I <br /> O H DEPTH TO G. W. : f FT SAMPLING METHOD <br /> N IJ/�- <br /> 0 ## OF HOURS SINCE DEWATERING: <br /> Qi' OTHER SAMPLE: <br /> LABORATORY. C�bl0(1p" SAMPLERS NAME:L H,,�t s <br /> CLOSURE IN PLACE MIXTURE: N VOLUME: <br /> H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />