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�a� 3 <br /> PHS-EHD - UNDZOUND TANK CLOSURE/AB <br /> ANDO NT INSPECTION <br /> `"= <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ` '' `"' '�u ;"� ;"6;�d;�y, <br /> E <br /> OWNER NAME�G _ Q t`("'A T6 PrTQ S TA Nl9-� � A177r <br /> OWNER PHONE # 0 <br /> NCONTRA TOR <br /> E <br /> V/,eo #M66,)-� N CON. PHONE# Ll QF- r7 7—/S"D i <br /> R SJLHD PERMIT EFA #�� 3-ZI �'�`?' I <br /> A . FIRE PERMIT <br /> L <br /> INS-PEC19prDATE Z & TANK # 31) - <br /> R RINSED (Y/(g METHOD ��^^ c� aVT RINSE AMOUNT <br /> I Ca� w 'I to <br /> N RINSATE DISPOSAL SITE •�7.�� �� �1,9't� <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) l METHOD <br /> A DRN AMOUNT USED <br /> T� F <br /> P L. E. L. READING AT REMOVAL (MUST BE ( :AUX) <br /> O �T <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEEL FIBERGLASS, OTHNK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) .G P rt,�1La. .� <br /> N ii <br /> S PIPE MATERIAL ( TEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SA PLE # <br /> F r A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X ._,Lgx YDS OF SOIL: �- <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SA PLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N 1 <br /> T G A - <br /> TRENCH DIMENSION.' <br /> X X oZ YDS Of SOIL /2-- <br /> 0 <br /> 0 H DEPTH TO G. W. : �{( FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE : <br /> DEWATERING: <br /> r} Jai,% <br /> 0 QTHER SAMPLE: <br /> LABORATORY: 7,�. L <br /> G©A/ C-0 f Gµr.� SAMPLERS NAME�<Aey /t4^Say✓ <br /> CLOSURE 'IN PLACE MIXTURE: VOLUME: <br /> EH 23043 (10/B9) DRAW SITE MAP ON REVERSE <br />