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PHS-EHD - UNDERGROTANK, CLOSURE/ABANDONMENT SPECTION <br /> (SHADED AREA TO ��ILLED IN FOR THE FIRST TPW ONLY) <br /> X/ih"ri..{r/i,J�!///X'/X'/XJ!/i/",,!/i /,°!/�Yi. i)DR�/'l/.7/iS"/ i,i.K�/i..'. <br /> I =SIV H ITI t <br /> :(WQ 1J 1J llktt tt �wHJ%//UiU//UlL/ Jd/U/ULr' <br /> OWNER NAME OWNER PHONE # �tirzac <br /> E S S 031 - ( t, <br /> Cy <br /> N CONTRACTORr� aN rN� CON. PHONE# 5/tJ _ Sy <br /> E _ �/ 3- /7500 <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> q ` ��� , <br /> L ' 11���,� �// I 1'I /Y 1. � %• v✓/�/ <br /> INSPECTOR DRTE / 7z TANK # 39 <br /> R I RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E I MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> R <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N 1 TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / I 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I i PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATIONI SAMPLE # <br /> T <br /> F q / 1 <br /> I N <br /> E K <br /> L <br /> D S —EXCAVATION SIZE: X X YDS OF SOIL: <br /> — <br /> I A I DEPTH SOIL TYPE OBSERVATION SAMG'LE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T 7 G TRENCH DIMENSION XX YDS OF SOIL <br /> I — <br /> 0 H DEPTH TO S. W. : FT SAMPLING METHOD <br /> N I 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> —011 OTHER SAMPLE: <br /> P�S/rg7i�, .rt <br /> LARCRATORY: i a SAMPLERS NAME:C& Hurt <br /> u 7 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />— I <br /> 1 23043 ( 10/89) DRAW SITE- MAP ON REVERSE <br />