Laserfiche WebLink
ri , _z i <br /> PHS-EHD - UNDERGROUNO TANK CLOSURE/ABANDONMENT 'NSPECTION <br /> (SHADED AREA TO E FILLED IN FOR THE FIRST Tr"oK ONLY) <br /> E '% OWNER- NAME o �� °� OWNER PHONE # <br /> ECONTRACTOR SEMS CON, PHONE# <br /> S.TLHD GERMIT # FIRE PERMIT 44�t ; <br /> 1LLS2 <br /> J <br /> INSpECTO DAT TANK # 39 <br /> R RINSED Y N) METHOD / RINSE AMOUNT �v <br /> N RINSATE DISPOSAL SITE <br /> S e � � /e, vh <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A AMOUNT USED 6 UO <br /> P <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20X) QTS <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEEL FIBERGLASS, OTHER) TANK SIZE �iOD <br /> K C �! <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> N <br /> S PIPE MATERIAL ( TEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I <br /> N <br /> E / O <br /> K <br /> L <br /> D EXCAVATION SIZE: � X _ X 12 YDS <br /> $ OF SOIL: <br /> I A I DEPTH SOIL TYPE OBSERVATION <br /> N M SAMPLE # <br /> S P <br /> P L P <br /> E I I I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I -- X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: A A L SAMPLERS <br /> CLOSURE IN PLACE MIXTURE: <br /> � VOLUME: <br /> H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />