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PHS-EHQ - UND LUNO TANK CLOSURE" BAND[(' ,T INSPECTION <br /> (SHAG. .. AREA �BE FILLED I N FOR- ,HE F IRS " TANK ONLY) <br /> E OWNER NAME OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> R SJLHD PERMIT # EPA # f <br /> FIRE PERMIT # <br /> A , <br /> L <br /> INSPECTORATE TANK # :,9 - 1671 _ L� <br /> R RINSED Y N) METHOD RINSE AMOUNT <br /> I rt h <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHOD <br /> A AMOUNT USED <br /> c <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STE <br /> K C �E FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION 000 POOR, HOLES) <br /> N <br /> z S PIPE MATERIAL TEFL _ FIBERGLASS, OTHER) # FEET <br /> P T �rrac,✓nrn du dP <br /> I PIPING CONDITION (GOOD, POOR, HOLES) P�'. <br /> N <br /> G DEPTH SOIL TYPE QBSERVATION <br /> T SAMPLE # <br /> F p <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: `z X YDS OF SOIL: / <br /> S � CO• S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p I SAMPLE # <br /> S P I 4i d <br /> P L P <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. ; <br /> N FT 7SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME <br /> rP c <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 22043 (10/69) DRAW SITE MAP ON REVERSE <br />