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PHS—EHD — UNDERGRGD TANK CLOSURE/AHAND 3 <br /> s ONMEN't INSPECTION ✓ <br /> • Vy, I(SHADE,yDp AREA!,� TTO ,yBE ,yFILLED Y N FOR THE F Y RST TANK ONLY) <br /> E OWNER NAME F L S OWNER PHONE # O ,3 j <br /> N CONTRACTOR . PHONE# <br /> CON"N ` <br /> R SJLHD PERMIT # �� EPA # <br /> A . FIRE PERMIT # <br /> L <br /> INSPECT DATE 3 �� 9v TANK # ,39 / .�-7 <br /> F <br /> R RINSED Y N) METHOD <br /> I / G ��,�/ RINSE AMOUNT D <br /> N - RINSATE DISPOSAL' SITE <br /> MN <br /> E °MANIFEST # 1� 06 ke <br /> -DR— OTHER <br /> V 0VAPORS PURGED /N) METHOD—/7Z/"/ <br /> A7 AMOUNT USED s' <br /> P READ I NG a' AT REMOVAL (MUST <br /> 0 BE < EUX) <br /> T R °%CDMMENTS •N' <br /> A E, <br /> N )TANK MATERIAL (STEE , FIBERGLASS,' OTHER) TANK SIZE <br /> K C <br /> / O ,TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIALSTEE , FIBERGLASS,' OTHER) <br /> T # FEET i <br /> P <br /> I A'.IPING CONDITION (GOOD, POOR HO <br /> N aF , LES) <br /> G DEPTH SOIL TYPE OBSERVATLON <br /> T �' SAMPLE # <br /> F A k. o 40 <br /> E K i5 <br /> L , <br /> D EXCAVATION IZE:S <br /> S ,, - X X` f Z YDS OF SOIL; <br /> I ADEPTH SDTL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P Z , 0 ✓1 U 0: <br /> P L p ya n� 4 1- <br /> E i E a� <br /> C N <br /> T G TRENCH DIMENS ON <br /> I h X XYDS OF SOIL <br /> 0 H DEPTH TO G. W. : <br /> N 2 ����.._ FT SAMPLING METHOD <br /> 0. # OF HOURS SINCE DEWATERING: . . <br /> O OTHER SAMPLE: <br /> LABORATORY: 66A5SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> 4, VOLUME: <br />! <br /> 23443 (l d/$9) <br /> ---Dl SITE MAP ON REVERSE <br /> 0 } <br />