Laserfiche WebLink
PHS-EHD - UNDERD TANK CLOSURE/ABANDON * ON <br /> J <br /> (SHADED AREA TOZCE FILLED IN FOR THE FIRST TANKONLY) <br /> OWNER NAME OWNER PHONE # <br /> N CONTRACTOR <br /> E =„ V_, CON. PHONE# <br /> = �cLr1% GL ��2 i <br /> i <br /> R SJLHD PERMIT # Cat Cti-o <br /> EPR # oc,_ n� 1 FIRE PERMIT # <br /> L - <br /> INSPECTOR DATE <br /> ”? I J TANK # <br /> R RINSED , Y/N) METHOD fYi+'✓ RINSE AMOUNT�o <br /> I <br /> N RINSATE DISPOSAL SITE ,+CK a C;- <br /> S �D �'V° TDLk <br /> E MANIFEST # <br /> AV VAPORS PURGED fly/N) METHOD L�Tt; CC^ AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST RE ( COX) J/J <br /> 0 <br /> T R COMMENTS <br /> R <br /> K C TANK MATERIAL (,(STEEL), FIRERGLASS, OTHER) TANK SITE <br /> / 0 TANK CONDITION (GOOD00 HOLES) Ccs r�I3Y� ea/ EJ yt c <br /> • N <br /> S F'IF'E MATERIAL "(STEEL) FIBERGLYA , OTHER) # FEET I �/ ��� <br /> P T <br /> I PIPING CONDITIO <br /> N N (GOOD;F'Od-ff-, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T # <br /> F A 1-1 Z ' /r t_4,�/ C DCiz- _ <br /> I N1 E (L i T <br /> E K 'tet 11�r I Fr nv <br /> L <br /> D EXCAVATION SIZE: X 31 X YDS OF SOIL.: , 1 �3 <br /> S 7 <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I h . C/Q /Yf J ? ! - l >t` dca ' <br /> F' L P T <br /> E I E 1 � )Cr ��� �� �, - 'i"^r` sty,.;,;. <br /> C N <br /> T G TRENCH DIMENSION X���'�' YDS OF SOIL. `� G� a�j� <br /> I <br /> 0 H DEPTH TO G. w. ,l FT SAMPLING METHOD _ <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: — <br /> LABORATORY: SAMPLERS NAME: Ae ')s Env Clp. A � <br /> CLOSURE IN PLACE MIXTURE: VOLUME: rJl& <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />