Laserfiche WebLink
PHS-EHD - UNDERC^-, JD TANK CLOSURE/ABANDONtO INSPECTION <br /> (SHADED AREA 1404 BE FILLED IN FOR THE FIRSN4IANK ONLY) <br /> , <br /> 7777 <br /> WNER NAMEOWNER PHONE N CONTRACTORE ,�,> ; CON. PHONE#R SJLHD PERMIT # 44c GOA <br /> A . EPA SM. # F IRE PERM I T # <br /> L <br /> INSPECTOR TANK # <br /> I RINSED f _ �/ES METHOD <br /> 4 RINSE AMOUNT <br /> N RINSATE D SPOSAL SITE < <br /> S <br /> E MANIFEST # -OR- OTHER <br /> rp VAPORS PURGED , ) �����AMOUN1 USED G� <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> T R COMMENTS <br /> A <br /> N TANK MATERI tSTEE , FIBERGLASS, OTHER) TANK SIZE // ,^ <br /> K C �i C�� CSL <br /> / O TANK COND I T'I ON (GOOD, OOR�' HOLES) C� <br /> N orrcs{N� t- <br /> • SLPIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> i <br /> Is— <br /> N <br /> L <br /> it <br /> D EXCAVATION SIZE: <br /> S X .Z_ X YDS OF SOIL: <br /> I A EPTH SOIL TYPESERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L IP <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> 0 H DEPTH TO G. W. : - FTSAMPLING METHOD <br /> N <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: �� 1 v9�L2�,r SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> N , <br /> EH 23043 (14/89) DRAW SITE MAP ON REVERSE <br />