Laserfiche WebLink
PHS-EHD - UNDERG&ND TANK CLOSURE/ABANDONMINSPECI-1011 <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRS' ANK ONLY) <br /> ",A"""Y�3tL�f�4 rul "6 <br /> E f OWNER E �v OWNER PHONE # fd 3��- <br /> e <br /> N < CONTRAC OR CON. PHONE# <br /> E 0 JO <br /> i <br /> R SJLHD PERMIT # EF'A # FIRE PERMIT # :'py�y � tyJ�y <br /> INSPECTOR DATE TANK # -39 - <br /> R RINSED (Y N) METHO RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED(<Y N) METHOD AMOUNT USED3(,,/v <br /> R <br /> FO L. E. L. READING AT REMOVAL (MUST BE--J< <br /> T R COMMENTS C� �Ai✓�� <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TfiNK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, F'DOR /HOLES) F G1_! <br /> N u cq�l L , <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE'f <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G <br /> T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A l <br /> I N # <br /> K E <br /> E S /U tE <br /> L <br /> D EXCAVATION SIZE: L X X � YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I 1S <br /> F' L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X --- X YDS Of= SOIL <br /> I — <br /> 0 H DEPTH 'f0 G. W. ; FT SAMP <br /> N ' <br /> LING METHOD <br /> – <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY " <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />