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PHS -EHD — UNDUND TANK CLOSURE/ABAND <br /> INPE <br /> (SHADED ARE ` <br /> BE FILLED IN FOR THE FIRS TANKSpIyCTION ; <br /> ' <br /> N LY) <br /> xog <br /> DF 30 <br /> OWNER NAME OWNER PHONE # <br /> i E s" "`p h v y-g 9 -a <br /> f N CONTRACTOR SGS CON. PHONE# <br /> E ;a <br /> R SJLHD PERMIT # C cUoo 6r� PA # <br /> A . FIRE PERMIT # ,Io,;e <br /> L <br /> INSPECTOR �= , DATE l�S` TANK 9 <br /> R RINSED t.3'/N) METHOD RINSE AMOUNT <br /> I G I <br /> N RINSATE DISPOSAL SITEI <br /> S r�d� <br /> f E MANIFEST # -OR- DTHER <br /> � I <br /> V VAPORS PURGED /N) METHOD AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < 26%) <br /> O (� <br /> T R COMMENTS <br /> A ; <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE "77 SDD <br /> K C h <br /> / O TANK CONDITION ( K'DOR HOLES) <br /> N v n sl l <br /> Y S PIPE MATERIA (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T ,, <br /> I PIPING CONDITION (GOD , P00 HOLES) j <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION '' SAMPLE # <br /> T ik <br /> F A <br /> I N 3 ! r� a r / 7' <br /> E K <br /> L :s ve -rFc:-- ey rrz <br /> I D EXCAVATION SIZE: <br /> S �IX X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION 'i SAMPLE # <br /> N M P I <br /> S P I I <br /> P L P v Fli. <br /> E I E <br /> C N I; ; <br /> T G TRENCH DIMENSION X X ii YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> n <br /> LABORATORY: <br /> - SAMPLERS- NAME: Ni <br /> f j. <br /> CLOSURE IN PLACE MIXTURE: ia° VOLUME: <br /> =H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />