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PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT ON <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANKONLY) <br /> E-NARE III ! <br /> 7NE <br /> ' L`C <br /> OWNER NAMEJC_ (,�>h�"�Sz L fir. OWNER 2L <br /> N CONTRACTOR O(L)tleJ� <br /> E CON. P ��,VJI _R SJLH PERMIT # fJIR- EPA #C�7CA PERMIT <br /> L <br /> INSPECTOR),411. ,b�j i�' DATE A �Gj %1 TANK # 39 <br /> R RINSED (Y/,1V) METHOD �V le rt n 5�IRINSE <br /> N RINSATE DISPOSAL SITE <br /> S Fes- ; Kvtc.e <br /> E MANIFEST # D I Z -OR- OTHER <br /> V VAPORS PURGED (Y,N) METHOD-Dry TC_ AMOUNT USED 'Zo l h5 <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEFIBERGLASS, OTHER) <br /> K CCJ TANK SIZE 0.00 <br /> / 0 TANK CONDITION (GOOD, �OOR, HOLES) Ah, holes' e nt but (,�nra�r;,. wuVCI <br /> N <br /> S PIPE MATERIAL (STEEL, /F I BERGLASS9 OTHER) # FEET < 7 G l <br /> P T <br /> I PIPING CONDITION (GOOD, OLES) (�. <br /> N il . <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A 77 ,7 d4 orr'T c; pd.w ow— <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 3ox X „� YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I t <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. : FT SAMPLING METHOD <br /> N 2 1 <br /> 0 # OF HOURS SINCE DEWATERING: Loa+c'r <br /> 0 OTHER SAMPLE: iliums✓ A sldtwal <br /> LABORATORY: �'L L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: Ey <br /> LUME: <br /> 23043 (10/89) DRAW SITE MAP ON REVERSE <br />