Laserfiche WebLink
4-IS-EHD - UNDERG ND TANK CLOSURE/ABANDONMk,,.4 INSPECTION <br /> (SHADED AREA T6J E FILLED IN FOR THE FIRST TANK ONLY) dL-p7 <br /> E OWNER- NAME OWNER PHONE # <br /> E CONTRACTOR CON. PHONE# <br /> r <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # z <br /> q . <br /> L <br /> INSPECTOR x � DATE �tl(o/9a TANK # 39 <br /> RRINSED /N) METHOD"r � RINSE AMOUNT <br /> I <br /> S RINSATE DISPOSAL SITE r ��� Q� <br /> r r <br /> E MANIFEST # Tia <br /> V VAPORS PURGEDY N) METHOD / �� AMOUNT USED <br /> A <br /> 0 L..E. L. READING AT REMOVAL (MUST BE < 20%) �v/p <br /> TT R COMMENTS U <br /> n <br /> N TANK MATERIAL (STEEL, BERGLAS , OTHER) TANK SIZE Sd �� d <br /> / 0 TANK CONDITION OOD, POOR, HOLES) /jo okvl&l 5 CLz C S l�ptg( <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEE"f <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A DO P1 <br /> I N . �3 <br /> E K 1o6m # <br /> L <br /> D EXCAVATION SIZE: 3'1{"X ' <br /> S ate'/ X .�, YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I ou f m <br /> P L P ca- <br /> E I E yrs <br /> C N <br /> T G TRENCH DIMENSION Sex X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : n LET SAMPLING METHOD — <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: �yElSAMPLERS NAME: -- <br /> CLOSURE IN PLACE MIXTURE: ��� VOLUME: ti/�� <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />