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C) <br /> PHS-EHD - UNDEAegCUND TANK CLOSURE/ SANDONi.,, T INSPECTION I <br /> (SHADED AREA TO BE FILLED IN FOR HE FIRST TANK ONLY) <br /> �. ;Ml <br /> IF <br /> YlA <br /> I} OWNER NAME OWNER PHONE # <br /> ! E � <br /> N CONTRACTOR _ CON. PHONE4 <br /> E I , <br /> R SJLHD PERMIT # EPA # tK <br /> FIREtERIT # - <br /> L � d <br /> { L <br /> Ktzi u 1 NINSPECTOR DATE. ( -�.1' 3 # .?� - <br /> 11 R RINSED fY N) METHOD Fu RINSE AMOUNT <br /> � I <br /> N RINSATE DISPOSAL SITE <br /> E S <br /> I I E MANIFEST # -OR- OTHER <br /> r V VAPORS PURGED(2/N)/N) METHOD +'R' ( ((L C AMOUNT USED <br /> 1 A <br /> i P L. E. L. READING AT REMOVAL (MUST BE < `OX) <br /> 0 <br /> AR I COMMENTS <br /> N TANK MATERIAL FIBERGLASS, OTHER) TANK SIE j <br /> K C <br /> / O TANK CONDITION � POOR, HOLES) u �V E !t- S e-, <br /> N <br /> I S i PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T i <br /> I I PIPING CONDITION (GOOD, POOR, HOLES) <br /> i N s f <br /> G DEPTH SOIL TYPE OBSERVATION E SAMPLE # <br /> T I. <br /> F A M <br /> N ; <br /> K <br /> L <br /> D EXCAVATION SIZE: X X L YDS OF SOIL: <br /> S <br /> I I A DEPTH SOIL TYPE OBSERVATI N SAMPLE # <br /> N M I P Is I <br /> S P I I "c <br /> P L R r <br /> E I E ' <br /> C N I i <br /> TG TRENCH DIMENSION X X YDS OF SOIL <br /> I E <br /> Q ! I H I DEPTH TO G. W. : FT SAMPLING METHOD , <br /> - = : N 2 } f� <br /> IE� # OF HOURS SINCE DEWATERING: + ` <br /> I � �;- <br /> si OTHER SAMPLE: <br /> 5 i ` <br /> I LABORATORY : I]I SAMPLERS NAME: <br /> CLOSURE iN PLACE y MIXTURE: VOLUME: <br /> 4 2-047 ( 10/89) 7RAW S:TW MAP ON REVERSE <br />