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f' •}` PHS-EHD = UNDEOUND TANK CLOSURE/ABANDON IN <br /> (SHAD,yED� ARE,A�ry... BE FILLED I,yN� FOR THE JlI FI RSPECTION <br /> ,y�1 <br /> TANK ONLY) <br /> 1 / i(v":Ev1 ��7ii v y '7a.?�r7v ��ia:Zv� �1ir�iili�'J1i/uvXti v ' '�r`�i NO, <br /> / dar <br /> OWNER- NAME ��o,� �•'� � slue OWNER PHONE # <br /> E /��sfyjG/ Avg - �5 9 4.i 3/ 6 <br /> N CONTRACTOR S�rr�Gp CON. PHONE# <br /> E <br /> R SJLHD PERMIT # <br /> C�s,E=9�oe�s EPA #C.9�voa��5o�a 'F I RE: PERMIT <br /> INSPECTOR C,�� DATE TANK ## 39 - /_3 _ o <br /> { R RINSED fp N) METHOD , RINSE NSE AMOUNT <br /> -4- <br /> I �v -2O a Q <br /> N RINSATE DISPOSAL SITE <br /> S q <br /> E MANIFEST # -S�7'"`O ��. s��/.�T 6 Le /4b _ OTHER <br /> I <br /> V VAPORS PURGED fqN) METHOD D <br /> A vy ITe- ' AMOUNT USED 3, <br /> ,I. P L.:E. L. READING AT REMOVAL (MUST BE <br /> O <br /> T R COMMENTS <br /> A II <br /> N TANK MATERIAL S EEL FIBERGLASS, OTHER) TANK SIZE SSO <br /> K C <br /> / O TANK CONDITION (GOOD, �00RHOLES) I11 <br /> N <br /> 1 S <br /> P T PIPE MATERIAL STEE FIBERGLASS, OTHER) #:; FEET 3 <br /> I PIPING CONDITION (GOOD, POOR HOLES) c <br /> € N <br /> G DEPTH SOIL TYPE OBSERVATION ' , <br /> # T Ir SAMPLE # <br /> F A � <br /> I N <br /> E K <br /> r L k <br /> D EXCAVATION SIZE: /a ` X (� ' fr I <br /> S X 1,� YDS OF SOIL: <br /> f I A DEPTH SOIL TYPE OBSERVATION '` <br /> N M P ' SAMPLE # <br /> S P <br /> R L P <br /> E I E <br /> C N <br /> .i' <br /> T G TRENCH DIMENSION X X <br /> I I YDS ,OF SOIL <br /> O H DEPTH TO G. W. : <br /> N 2 ------_� FT SAMPLING METHOD �� - <br /> U # OF HOURS SINCE DEWATERING: <br /> !! 0 OTHER SAMPLE: <br /> 1 LABORATORY: <br /> E Cae�p�G/ c�OL SAMPLERS NAME: 0a.--72Lc.Geu Q <br /> CLOSURE IN PLACE MIXTURE: <br /> .� VOLUME: <br /> ,t <br /> ->-! E3043 ( 14/84) DRAW SITE MAP ON REVERSE <br /> i <br />