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PHS-EHD - UNDER ANDON INSPECTION <br /> (SHADED AREA T ED TANK CLOSURE/ABFILLED IN FOR THE FIRST ONLY) <br /> OWNER NAME OWNER PHONE # <br /> N .. . CONTRACTOR <br /> E CON. PHONE# <br /> RA .j SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L / <br /> INSPECTOR ~LL� DATE TANK # 39 <br /> R RINSED ((Y/N) METHOD ��i x RINSE AMOUNT�Q <br /> I �i )• � <br /> N RINSATE DISPOSAL SITE <br /> S SzRny• � <br /> E MANIFEST # 7/r2f <br /> —OR— OTHER <br /> V VAPORS PURGED (Y/N) METHOD �ri lCQ AMOUNT USED <br /> A i 2eC-rF '_ <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL` 1(STEE�, FIBERGLASS, OTHER) TANK SIZE (OCbO <br /> K C iz IL <br /> / O TANK CONDITION (GOOD, OOR HOLES) O bYPJv <br /> N S COrlc75 iG`'� <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET �e <br /> T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N oo1 -u -gip <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A I —1? <br /> *r � r <br /> I a <br /> L K U / i� 4—, i ,� TS Z EG'e1 ,r )� <br /> O EXCAVATION SIZE: X .3.1 XYDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> E I E <br /> C N - <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G. W. : r'S L,, FT <br /> N 2 SAMPLING METHOD _ <br /> G # OF HOURS SINCE DEWATERING: _ <br /> 0 OTHER SAMPLE: _ <br /> LABORATORY: tiL� <br /> I SAMPLERS NAME: '�6 (—nvnz.�,•,{',,'1"'.i �� ,n•l�r;lr -t?cfii <br /> CLOSURE IN GLACE MIXTURE: flip- <br /> VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />