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PMS--EHD -- UNDJOROUND WANK CLOSURE/ABANDA <br /> (SHADED ARE TO BE PILLED IN FOR THE FIRST NTANK SONCTTON <br /> ONLY <br /> i OWNER- NAME <br /> OWNER PHONE # f <br /> N ,y CONTRACTOR CA 0 �4 f/ Y <br /> E lie . <br /> CPN. PHONE#( �(��' a/ <br /> R i SJLHD PERMIT 7 <br /> A . , . , ## " <br /> EPA # <br /> FIRE PERMIT # a <br /> L <br /> INSPECTOR k+i S DATE <br /> 10 � TANK <br /> R RINSED Y N) �--- - <br /> I METHOD RINSE A OU <br /> N RINSATE DISPOSAL SITE <br /> S <br /> M <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED (Y/N) -�� <br /> A METHOD AMOUNT USED <br /> f:` L. E, L. READING AT REMOVAL <br /> O (MUST BE ( 20%)} <br /> T R COMMENTS <br /> A <br /> N TANK MA'CERIA <br /> K C E FIBERGLASS, OTHER) TANK SIZE <br /> N <br /> / O TANK CONDITION (GOOD, POOR HOLES) <br /> S PIPE MATERIAL (STE11 EL v- <br /> P , FIBERGLASS, OTHER) It FEET <br /> I <br /> N WIPING CONDITION (GOOD, POOR, HOLES) <br /> G DEPTH SOIL TYPE <br /> T OBSERVATION <br /> F A � <U: ,�, �, SAMPLE # <br /> I N r� <br /> ,r <br /> S <br /> EXCAVATION SIZE: X <br /> X YDS OF SOIL: <br /> I A <br /> N M P DEPTH SOIL TYPE OBSERVATION <br /> S P I SAMPLE # <br /> P L P <br /> E I E <br /> C N <br /> T TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W• : <br /> N 2 ------ FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ,ro 6 <br /> L .P+ k-4 b5 SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> EH 22043 ( 10/89) VOLUME: <br /> DRAW SITE mnP ON REVERSE <br />