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S <br /> PHS--EHD - UNDE►; .. <br /> ]UND TANK CLOSURE/ASANDONm' NT INSPECTION <br /> (SHADED AREA TO BE FILLED-IN FOR THE FIRST TANK ONLY) <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR, <br /> ECON. PHONE# <br /> R SJLHD E RM I T # EPA #^cvvo� g <br /> / SJ <br /> A FIRE PERMIT # <br /> INSPECTOR C 67 v DATE TANK # 39 <br /> R RINSED CY/N) METHODf! 101- � ' <br />.. I '��e AMOUNT �d� <br /> N RINSATE DISPOSAL SITE ? <br /> S7,1 <br /> E MANIFEST # <br /> -OR- OTHER <br /> ---------------- <br /> V VAPORS PURGEDY )N) -.__.._. <br /> Al METHOD 7)r rte . -AMOUNT USED /�? s <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20%) y,v <br /> 0 <br /> p .l <br /> T R COMMENTS a <br /> A <br /> N TANK MATERIAL (STEEL, FILERGLASS ; <br /> K C OTHER) "TANK SIZE <br /> / O TANK CONDITION (GOOD, POOR, HOLES) <br /> N _ <br /> S PIPE MATERIALE�, FI LASS, OTHER) <br /> T # FEET <br /> P <br /> C >v <br /> I PIPING CONDITION ­' GOO /'POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION - � <br /> T SAMPLE # <br /> F A 3 , S .. <br /> I N Esc / <br /> E K ?-IA <br /> L <br /> D X EXCAVATION SIZE: ( "S X /� ' 6 <br /> S -�- -� _ � YDS` OF SOI L, <br /> I A DEPTH SOIL TYPE "OBSERVATION N ...M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSI <br /> I X X YDS OF SOIL <br /> O H DEPTH TO O. W. : <br /> N 2 -------.--� FT SAMPLING :METHOD <br /> Cl # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE. <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br />:H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />