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PHS-EHD R_ .OUND TANK CLOSURE/ABA�i Ih�NT INSPECTION <br /> (SHADEI D TO BE FILLED IN FOR THE �"iRST TANK ONLY) <br /> FEN <br /> OWNER NAME OWNER PHONE # <br /> CONTRACTOR <br /> CON. PHONE# <br /> R SJLHD PERMIT # EPA # <br /> A- FIRE PERMIT # <br /> L <br /> INSPECTOR ,�je DATE �j /q� TANK # 39 - - <br /> R RINSED (Y J METHOD <br /> I 7'RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E (MANIFEST -OR- OTHER <br /> V VAPORS PURGED YEN) METHOD ,, <br /> A � fCF AMOUNT USED !n] <br /> P L.E. L. READING AT REMOVAL (MUST BE ( 20X) <br /> 0 �o CEL- <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> 0 TAW CONDITION <br /> N <br /> S PIPE MATERIAL tE <br /> P �ELfFIBERGLASSI OTHER)T* FEET rl� �- o�P ✓ <br /> T 1 t� <br /> I PIPING CONDITIONGOOD POOR, HOLES) , // <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T \ SAMPLE # <br /> F A 5rcr/corm .----- <br /> I N t 1-r-- '�- 1 Ccri <br /> E K L <br /> L <br /> D S EXCAVATION SIZE: /r, X 1 X �� YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I Pi.77 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION —X <br /> I X YDS OF SOIL— <br /> O H DEPTH TO G.W. ; LLEl"��, w FT SAMPLING 3 NG METHOD <br /> N <br /> 4 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> lU ;�}- ___VOLUME: Nl -- <br /> EH 23043 (14/89) DRAW SITE MAP ON REVERSE <br />