Laserfiche WebLink
E <br />N <br />E <br />R <br />A <br />L <br />T <br />A <br />N <br />K <br />A <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />N <br />S <br />P <br />E <br />C <br />PHS-EHD - UNDEMkROUND TANK CLOSURE/ABANDONT INSPECTION <br />(SHADED AREA Mb BE FILLED IN FOR THE FIO <br />TANK ONLY) <br />HOURES 'ffffqmwmf" <br />OWNER NAME <br />OWNER PHONE # <br />2c?2-2W <br />CONTRACTOR CON. PHONE# <br />SJLHD PERMIT # EPA # <br />C 2�q3 FIRE PERMIT #I - - -- ------- - - 13/2-461 <br />ILIVIVUKI-MY <br />INSPECTOR N DATE 5/31/fa TANK # 390.3 <br />LO6 5 <br />R RINSED <br />I 7Y) 1 METHOD RINSE AMOUNT <br />' /� res <br />N RINSATE DISPOSAL SITE <br />T <br />S sl L^ <br />E 11 MANIFEST # <br />-OR OTHEF <br />J V VAPORS PURGED (Y N) METHOD <br />A <br />P L.E.L. READING AT REMOVAL (MUST 20%) <br />0 <br />R COMMENTS <br />V <br />VAPORS PURGED <br />L ADI <br />L. <br />EMATERIAL <br />RE NI <br />P <br />0 <br />R COMMENTS Co <br />TA MAT JAL <br />C r _TANK MATERIAL�(STEEL) FIBERGLASS, OTHER) <br />0 TANK CONDITION (GOOD, POOR LES) <br />N <br />------------- <br />S PIPE MATERI(STEEL.-) FIBERGLASS, OTHER) <br />T <br />PIPING CONDITION (GOOD POOR, OLES) <br />TION (GOOD POOR <br />SOIL TYPE OBSERVATION <br />SDI <br />T <br />'r <br />A <br />N <br />DEPTH SOIL TYPE OBSERVATION <br />T or <br />A <br />N <br />71d, -I <br />K <br />S <br />M p <br />P I <br />L P <br />I E <br />N <br />EXCAVATION SIZE: X 1' X __JL <br />DEPTH SOIL TYPE OBSERVATION <br />ri <br />AMOUNT USED <br />TANK SIZE ( <br />SAMPLE # <br />YDS OF SOIL: Zdrl ws <br />SAMPLE # <br />G TRENCH DIMENSION ®X <br />L- X 3' <br />Li YDS OF SOIL <br />H DEPTH TO G. FT SAMPLING METHOD <br />N <br />DIMENSION X X 3 D <br />I YDS <br />SOIL <br />0 W <br />OH DEPTH <br />G SAMPLING METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />7 ....... .... <br />LABORATORY: <br />B <br />A SAMPLERS NAME: <br />Do,, <br />CLOSURE IN PLACE MIXTURE: VOLUME:* <br />EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />