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PHS—EHD — UNDERG iND TANK CLOSURE/ASANDONhiL,,,. INSPECTION <br /> (SHADED AREA TG-BE FILLED IN FOR THE FIRST TANK ONLY) <br /> -2—7-1 rg'�rnpmff ffIll'4111241, <br /> OWNER NAME OWNER PHONE # I <br /> E <br /> N CONTRACTOR CON. F�HONE# <br /> E r1 L i <br /> R t SJLHD PERMIT # <br /> A �, , ERA # FIRE PERMIT it t? 16 / <br /> J <br /> INSPECTOR 1dv DATE -7 TANK # 39 — <br /> R RINSED /N) METHOD'`,, <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # 5Y3l: 3c7D —OR— OTHER <br /> V VAPORS PURGED (Y/N) METHOD <br /> A AMOUNT USED <br /> 1:1 L. E. L. READING AT REMOVAL (MUST BE < 2,OX) <br /> 0 `f °?- <br /> T R COMMENTS <br /> A <br /> N TANK MATER I AL - ( TTCEL,' FIBERGLASS, OTHER) TANK SIZE <br /> Z E <br /> K Cc'�z � <br /> / 0 TANK CONDITION (GOOD F000— <br /> HOLES) <br /> N f <br /> • S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> L <br /> D S EXCAVATION SIZE: X X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I — <br /> X YDS OF SOIL <br /> — <br /> 0 H DEPTH TO G. W. <br /> N FT SAMFLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �1 (� SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME : <br /> EH 3043 ( 10/89) DRAW SITE MAP ON REVERSE <br />