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Ilk <br /> fj <br /> PHS-EHD - UNDE AND TANK CLOSURE/ABANDONM INSRECT 'ON <br /> (SHADED AREA TO BE _FILLED IN FOR�yTHE <br /> FIRST TANK ONLY) <br /> ro rn aM. Iqoy 'J. <br /> E OWNER NAME �0 / v� �� OWNER PHONE # <br /> ECONTRACTOR J'1 GI �1 CON. PHONE# 0 q_ .12� s'1/ <br /> R SJLHD PERMIT # iEN TD98 FIRE PERMIT # <br /> A . <br /> INSPECTOR,,Z DATE�2 2� TANK # 39 <br /> I <br /> RINSED ( N) METHODrt�• RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE �2FF1 ���A3 S�VI cG Q L�e f, �/I— <br /> S' 7 c�T <br /> E MANIFEST # —OR— OTHER <br /> VV VAPORS PURGEDY N) METHOD-pg �L c AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST B ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK. SIZE <br /> /� 0 <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> ~a S PIPE MATERIAL �EE FIBERGLASS, OTHER) # FEET C�" � !_ <br /> P T ✓ l u�u.K.. <br /> I I PIPING CONDITION (GOOD, POOR OLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A C Gt /b !� ac. <br /> I N c / I <br /> E K <br /> L <br /> D EXCAVATION SIZE: �� X ISS X I r-� <br /> YDS OF SOIL: I� <br /> S <br /> I A DEPTH SOIL TYPE Ba VAT I ONS CS N K Sj�MF'LE # <br /> N M P 4 <br /> S P 1 <br /> P 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 TO G. W. : � 7,0 /FT SAMPLING METH? <br /> N ae <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: [::GL v,2.ONMG SAMPLERS NAME:M C 6/ZoGk <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />