Laserfiche WebLink
i <br /> PHS--EHD - UNDEF' `7UND TANK CLOSURE/ABANDONf �T INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE 3FIRS, •TANK ONLY) <br /> OWNER- NAME <br /> E OWNER PHONE # <br /> rv� �e S <br /> I N CONTRACTOR CON. PHO E# <br /> I EP5 yn ff� s <br /> R SJLHD RMIT # EPA # FIREIPERMIT # <br /> I ' <br /> L <br /> INSPECTOR <br /> L , L2 Z�, DATE shy/ TANK # 33 <br /> R RINSED f(QJN} METHOD ��i FRINSE AMOUNT <br /> I c� g <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED (O N) METHOD. L /c h AMOUNT USED <br /> A /O <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20"%) <br /> lO 0 <br /> T R COMMENTS <br /> N TANK MATERIALSTEEL FIBERGLASS, OTHER) TANK SIZE vo <br /> K C -- � <br /> / O TANK CONDITION (GOOD POOR HOLES) � <br /> r <br /> N i <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION Il <br /> TSAMPLE # <br /> II <br /> F <br /> I N /o <br /> E K <br /> L <br /> D EXCAVATION SIZE: X � X g �/ YDS OF SOIL:S s0yP <br /> I A DEPTH SOIL OBSERVATIO j <br /> N M p SAMPLE # <br /> S P <br /> P L P <br /> E I E it <br /> C N ; <br /> T G TRENCH DIMENSI0 X X IYDSOF L <br /> I <br /> 0 H DEPTH TO G. _ FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> i� <br /> 0 OTHER SAMPLE: <br /> LABORATORY: u o�� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: I VOLUME; <br /> -H 2w443 (14/89) DRAW SITE MAP ON REVERSE <br />