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I ' <br /> sem' PHS-EHD -- UNDERTF BIND TANK CLOSURE/ABANDONM , . INSPECTION <br /> (SHADED rA��REAL/ TO BE FILLED? IN FOR THE FIRST TANK ONLY) <br /> cc � <br /> "Jv�it 3iPuv a1 <br /> ;i <br /> 7OWNEER, NAME OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD Pttle <br /> # EPA # + FIRE PERMIT # <br /> A ' <br /> i <br /> L <br /> ,T <br /> INSPECT �S DATE / 31 l TANK # <br /> R RINSED (Y N) METHOD s <br /> RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE! <br /> S <br /> E MANIFEST # -DR- OTHER <br /> V VAPORS PURGEDo <br /> N) METHOD AMOUNT USED <br /> A <br /> P L. E. L. READING AT REMOVAL ('MUST < 20%) <br /> O r <br /> T R COMMENTS <br /> A <br /> K C TANK MA"T"ERIAL STEEL, FIBERGLASS; OTHER) TANK SIZE3S <br /> / N TANK CONDITION (GOOD, POOR,;' HOLES)r <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET" <br /> P T <br /> I PIPING CONDITION (GOOD, POOR; HOLES) f ' <br /> N " si <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE #. <br /> T " a <br /> F A ii <br /> I N i <br /> E K i <br /> L :s a <br /> D EXCAVATION SIZE: X,l X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION {� SAMi='LE # <br /> N M P ? <br /> S P I <br /> ._L.. . <br /> C N <br /> T G TRENCH DIMENSION X '� X YDS OF SOIL <br /> N H DEPTH TO G. W. : FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: " <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: s ry VOLUME: <br /> i <br /> EH 23043 ( 10/89) <br /> DRAW SITE MAP ON REVERSE <br /> j <br />