Laserfiche WebLink
PHS-EHD - UNDERD TANK CLOSURE/ABANDON INSPECTION 01c <br /> (SHADED(SHADED AREA FILLED IN FOR THE FIRrx ST NK ONLY) <br /> OWNER NAME OWNER PHONE # <br /> CONTRACTOR CON. PHONE# <br /> E � <br /> R SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # <br /> L <br /> INSPECTOR �� - <br /> DATE �I TANK # 39 <br /> R RINSED LY/N) METHOD '� vC 2�tiu <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # '-' -i- -OR- OTHER <br /> V VAPORS PURGED /N) METHOD \(� ( AMOUNT USEDA A ��c;o�o <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) g c)/ <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTEE , FIBERGLASS <br /> K C , OTHER) TANK SIZE <br /> / 0TANK CONDITION (GOOD, POOR OLES) � o r, ,�k ' ' <br /> N �� llLi C k eG�sir <br /> S PIPE MATERIAL (STEEL, FI,BERGLASS�-,OTHER) # FEE"f <br /> T �L_ <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> I N <br /> E <br /> L <br /> 0 EXCAVATION SIZE: X X <br /> S YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I � <br /> P L P u <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> O H DEPTH TO G. W. F12 c <br /> N 2 ,AMPLING METHOD — <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: N T SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: olp J <br /> EH 22043 ( 10/89) DRAW SITE MAP ON REVERSE <br />