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PHS-EHD UNDERGR,y; ND TANK CLOSURE/ABANDONME ' INS��EC1'ID! <br /> „ (SHADED AREA TO`` FILLED IN FOR THE FIRST ONLY) ft <br /> I., mm <br /> E %! OWNER NAME / el'6X OWNER PHONE <br /> N i' L <br /> CONTRACTOR � CON.' PHONE# 5 <br /> E �i'C1�!eR N Sf <br /> R SJLHD PERMIT #t X1-7 Z ;�2 <br /> A . FIRE PERMIT # �- <br /> J <br /> J <br /> I NSPECTO <br /> DATE TANK # „9 / <br /> -I d -- L� Z._...,. - D <br /> R ;: RINSED (Y METHOD <br /> I ��., G✓�� RINSE AMOUN C <br /> N ` RINSATE DISPOSAL -SITE <br /> S <br /> L FMANIFEST ## -QR- OTHER <br /> V VAPORS PURGED N) ME7HODQ� � <br /> A AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS w <br /> A <br /> TANK MATERIAL (STEEL, . IBERGLASS OTHER) TANK SIZE <br /> K C <br /> D TANK CONDITION (GOOD, POOR, HOLES) GB� <br /> N <br /> 1 S 'IPE MATERIAL (STEEL ' F. BERGLASS, <br /> P T ##OTHER) FEET <br /> I PIPING CONDITION (GOOD, FLOOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> I N -� �✓ ,r, ti ,NOle- <br /> Q all- - <br /> E K <br /> L <br /> D EXCAVATION SIZE: . "�' "` - <br /> S x x YDS OF SOIL: Spm¢- <br /> I q <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M p . SAMPLE # <br /> S P I. . <br /> P L p <br /> E I E <br /> C N <br /> T G j TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> F] H DEPTH TO C. W. <br /> N : F T SFIMPL I NG METHOD <br /> HDD <br /> --- <br /> G # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: - ' <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> WAle <br /> CLOSURE IN PLACE MIXTURE: � G <br /> VOLUME: <br /> EH 2'32'043 (10/89) DRAW SITE MAP ON REVERSE <br /> Y <br />