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PHS-EHD - Uh""r ROUND TANK CLOSURE/ARAN'^ANT INSPECTION <br /> (SHADED AV t`FO BE FILLED IN FOR THE V ,RST TANK ONLY) <br /> If 'lye ri <br /> OWNER NAME OWNER PHONE # <br /> E cc�C�, Cod <br /> N CONTRACTOR0-1S Co�S o10� CON. F�HONE# <br /> E � <br /> R / SJLHD PERMIT # EPA #A . FIRE PERMIT # <br /> a <br /> INSPECTOR �+ DATE �v TANK # <br /> R RINSED (Y N) METHOD, ,/� 1""Scr1 o RINSE AMOUNT <br /> I / <br /> N R I NSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGE (Y N) METHOD AMOUNT USEDA, �Sd�65 <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEEL FIBERGLASS, OTHER) TTANK SIZE <br /> K C <br /> P P <br /> / 0 TANK CONDITIO (GOOD, POOR, HOLES) <br /> N <br /> , S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) T# FEET t�l <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH jSOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A /Va d rvoI N �� �x o orS4 r1tscoFT <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I <br /> FT YDS OF SOIL <br /> 0 H DEPTH TO G. W. : SAMFL LING METHOD <br /> N 2 - <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY:,Lr SAMPLERSEN / <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> `.H 23043 (10/69) DRAW SITE MAP ON REVERSE <br />