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PHS--EHD UNDERGROUND TANK CLOSURE/ABANDONMENT;: 'NSPECTION !' r. �y�.. <br /> (SHADED AREA TO I' 'BILLED IN FOR THE FIRST Tt ONLY) ,; V <br /> ,� � �t��f g � �X13 � � � �L v.�A•�o 'YA Y,L of <br /> ��� Yk <br /> � <br /> OWNER- NA OWNER PHONE # <br /> N CONTRACTOR CON. PHONE# <br /> RS3LHD PERMIT # #��� FIRE PERMIT # f3NO 66" Fp <br /> INS PECTO jN Ij DATE&,/ TANK # <br /> R �h RINSED :i( /N) METHOD RINSE AMOUNT <br /> I -� . <br /> N RINSATE DISPOSAL SITE <br /> S <br /> MANIFEST # —OR— OTHER <br /> V VAPORS PURGED (Y N) ' METHOD AMOUNT AMOUNT USED <br /> A ikw <br /> 0 L.,E. L�. READING AT REMOVAL (MUST RE ( 20%) J 0 <br /> T R COMMENTS <br /> A <br /> ,a <br /> N TANK .MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE 7 <br /> K C L;r�c <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> N <br /> A. S PIPE 'MATERIAL STEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR HOLES) <br /> N ; <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N n <br /> E K ;3 <br /> L <br /> D EXCAVATION SIZE: X X yDS OF SO I L: 5'er GI�o <br /> S � <br /> I A DEPTH <br /> N M SOIL TYPE OBSERVATION SAMPLE # <br /> 3, <br /> '° <br /> S P -3 z>4, <br /> P L AlaL <br /> E I <br /> T G TRENCH D I MEN IDN Z X X 9l0 Y S OF SOIL �•v <br /> I. <br /> 0 H DEPTH TO G. W. ; 3s+� FT SAMPLING METHOD <br /> N <br /> G #i-OF HOURS SINCE DEWATERING: <br /> 0 LOTHER SAMPLE: <br /> LABORATORY: SAM�ILERS NAME: . <br /> CLhgSURE IN 'PLACE MIXTURE: VOLUME <br /> ,EH 22043 ! ( 10/$9), DRAW SITE MAP ON REVERSE <br /> `i <br />