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OHS--EHD - UNDE'�pUND TANK CLOSURE/A$ <br /> (SHADED AREA TO BE FILLED ANDONRNT INSPECTION <br /> NFOR THE FIRST TANK ONLY) DN <br /> f t <br /> � M <br /> OW NAME (,� <br /> E ,y CONTRACTOR S OWNER PHONE # , <br /> R CON. PHONE# G'� <br /> SJLWD PERMIT # <br /> A ,7 ol � ] <br /> 9 , <br /> EPA # .7 <br /> ` IRE <br /> L F <br /> ' , PERMIT # <br /> INSPECTOR kt r <br /> p <br /> Sc- DATE 8 TANK # <br /> R RIN SED (Y N) <br /> I METHOD /rte <br /> RINSE <br /> N R INSATE DISPOSAL SITE AMOUNT 5 S <br /> S <br /> E MANIFEST # <br /> V VAPORS PURGED <br /> N) -OR- OTHER <br /> A METHOD <br /> PL. E. L, n f AMOUNT USED <br /> D READING AT REMOVAL (MUST 8f <br /> COMMENTS <br /> A <br /> N TANK MATERIA <br /> K C (STEEL FIBERGLASS, <br /> / N (GOOD, 'DGR OTHER) TANK SIZE <br /> 0 TANK CONDITION HOLES) <br /> S PIPE MATERIAL (STEEL <br /> P T , FIBERGLASS <br /> I OTHER) # FEE"r <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> F A SAfy ## <br /> I N .eC <br /> E K <br /> L <br /> D EXCAVATION SIZE;TH SOX �- µ '; <br /> I A DEP X -�=-- YDS OF SOIL : <br /> N M p IL TY�'E OBSERVATION <br /> S P I SAMPLE # <br /> P L P <br /> E I �. <br /> C N <br /> G TRENCH DIMENSION <br /> I <br /> O H X � x � YDS OF SOIL <br /> N H DEPTH TO G. W, : <br /> --- FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: L �E�, SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br />:H `,`,043 ( 14/D9) VOLUME <br /> DRAW SITE MAp ON REVERSE <br />