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I <br />T <br />A <br />N <br />K <br />A <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />N <br />S <br />P <br />E <br />C <br />PHS—EHD — UNDEJkROUND TANK CLOSUREIRBONDO&NT INSPECTION <br />(SHADED ARE AW BE FILLED IN FOR THE FIMerr TANK ONLY) <br />MmIt/"//V/"//Af/,*M"/AV,f",fv,V&Ila'I . . . .. ................. <br />OWNER NAME OWNER PHONE # <br />CONTRACTOR CON. PHONE# <br />SJLHD PERMIT #_j EPA # FIRE PERMIT # <br />INSPECTOR DATE 0TANK # 39 <br />R RINSED <br />I MET I HOD_ TRINSE AMOUNT <br />N RINSATE DISPOSAL SITE— <br />S <br />E MANIFEST # —OR— OTHER <br />V <br />VAPORS PURGED'(Y <br />METHOD� <br />P <br />L.E.L. READING <br />AT REMOVAL (MUST BE < 20%) <br />0 <br />R <br />COMMENTS <br />TANK MATERIAL <br />(STEEL, FIBERGLASS, OTHER) <br />c <br />0 <br />TANK CONDITION <br />(GOOD, POO HOLE <br />N <br />S <br />PIPE MATERIAL <br />(STEEL, FIBERGLASS, OTHER) <br />T <br />S <br />A <br />M <br />P <br />L <br />I <br />N <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />DEPTH <br />SOIL TYPE OBSERUQTTnm <br />I <br />P <br />I <br />P <br />E <br />AMOUNT USED <br />TANK SIZE 12 <br /># FEET <br />EXCAVATION SIZE: X 3_� X Js YDS OF SOIL: <br />DEPTH I SOIL TYPE OBSERVATION <br />G TRENCH DIMENSION X X <br />YDS OF SOIL <br />0 H DEPTH TO G. W.: FT <br />N SAMPLING METHOD <br />S OF <br />Y� <br />X <br />107 SAMPLING METHOD T <br />0 # OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />LABORATORY: e12 s— <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME. <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />I SAMPLE # <br />SAMPLE # <br />