Laserfiche WebLink
PHS--EHD – UNDERG* ,,D TANK CLOSURE/ABANDONMEVI—INSPECTION <br /> / (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> ff_T ! ti7 f D <br /> OWNER- NAM <br /> E E/) llc_ OWNER PHONE # <br /> Nj , CONTRACT0 L CON. PHONE# <br /> E ��o5-_w7-��r8/ <br /> R SJLHD PERMIT # EFTA #UCV�z"S �6S' FIRE PERMIT # `jQ--- doa <br /> A • , <br /> LlK <br /> IN O R DATE it,:�6_ �� TANK # .39 <br /> R RINSED /N) METHOD RINSE AMOUNT <br /> S /�g 1 RINSATE DISPOSAL SITE ,. S-XV <br /> E MANIFEST # –OR– OTHER <br /> V VAPORS PURGED &N) METHOD <br /> A /)/)/<? „zOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST B ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL STEE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION DOD POOR, HOLES) keleIIS 0//'..yv-+�C' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N 15 <br /> E � � . <br /> K <br /> L <br /> Dlfr&VATION SIZE: •Z X .3� X � YDS OF SOIL: <br /> S �S 7130( <br /> I A DEPTH IL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P x <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO G. W. ; <br /> N FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORA.TORYs F� SAMPLER., NAME. �. <br /> �' MR,c k fs k oc k <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />^:H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />