Laserfiche WebLink
PHS-EHD - UNDERGdbND TANK CLOSURE/ABANDONMj <br /> (SHADED AREA Typ(pOnEpy�yF�ILLED IIyN�/ FOR THE <br /> FIIR�S�yTp ,y1�'yAuNK�yINSPECT <br /> ONLY)ON�y��y��y�y�y� <br /> ,! OWNER NAME 9t3 1 L <br /> E DNV OWNER PHONE <br /> E ,� CONTRACTOR / f CON. PHONE# <br /> A -j SJLHD PERMIT # EPA # FIRE PERMIT # - % <br /> L <br /> IN DATE _ TANK # <br /> i <br /> R RINSEp Y N METHOD Z4 <br /> I �S¢ RINSE AMOUNT Z <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> RVAPORS PURGED Y/N) METHOD PA AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A /7L <br /> N <br /> C TANK MATERIAL STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K <br /> / 0 TANK CONDITION (G <br /> N , POOR HOLES) <br /> S PIPE MATERIAL (STEEL IBERGLASS, UT HER) it FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> Nr <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F R <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: � X C/ X c c <br /> S _J2_ L 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 <br /> I X X YDS Of. SOIL <br /> O H DEPTH TO G. W. ; <br /> N _ F'T SAMPLING METHOD <br /> U # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VULUhIE <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />