Laserfiche WebLink
PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMEN-' INSPECTION <br />(SHADED AREA TO FILLED IN FOR THE FIRST CNK ONLY) Id L 5 <br />jam..;. OWNER NAME 3% <br />N CONTRACTOR (/ <br />E r, /)b OWNER PHONE # /%] ({y <br />I.E <br />/ D 4 <br />Z% CoR 14— N. 0 Ek <br />I Y — P O� 20 q <br />i R ,� SJLHD PERMIT # �f ��32 ����' <br />A• 6�j A i1�%�S2083 FIRE PERMIT # 1� <br />IN PE R DATE J <br />---ln �-� TANK q S9 _ �_ _ <br />R RINSED (Y N) METHOD 17!WmZ,tiFI w/ <br />AMOUNT <br />N RINSATE DISPOSAL SITE r/ <br />S <br />E MANIFEST la <br />-OR- OTHER <br />V VAPORS PURGED lY N) METHOD <br />A 02 Z�� AMOUNT uSED SU s <br />I D L.E.L. READING AT REMOVAL (MUST BE ( lo -/3 (EL = <br />T R COMMENTS D <br />A <br />N TANK MATERIAL STEC , FIBERGLASS, OTHER) TANK SIZE <br />K C <br />/ O TANK CONDITION (GOOD, POOR HOL- �QUp� <br />N <br />S PIPE MATERIAL (STEEL, FIBERGLASS <br />P T , OTHER) 8 FEET <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />G I DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE li <br />j F A v <br />I N O <br />E K o o� <br />L <br />D EXCAVATION SIZE: �J <br />S �* X %� X <br />I YDS OF SOIL: <br />A DEPTH SOIL TYPE OBSERVATION N M SA hi ILE # <br />S P / IN <br />P L <br />E I <br />C N <br />T G TRENCH DIMENSION <br />I -- X -- X YDS OF SOIL <br />0 H DEPTH TO G. w. <br />N FT -t- SAMPLIN METHOD <br />0 # OF HOURS SINCE DEWATERING: <br />O OTHER SAMPLE: <br />j LABORATORY: �-r C SAMPLERS NAME:' E <br />CLOSURE IN PLACE MIXTURE: <br />� VOLUME; <br />EH 2.2.043 (10/89) DRAW SITE MAP ON REVERSE <br />