Laserfiche WebLink
PHS-EHD - UNDERGa, JND TANK CLOSURE/ABANDONME-#T INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST "TANK ONLY) <br /> GLN a �� <br /> E OWNER NAMES OWNER PHONE # �( / n <br /> n�- <br /> E 0 CONTRACTOR�.LC -� C „- �L S1�' CON. PHONE# 7 <br /> 3-3 <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A _ <br /> L <br /> R RINSED tY N) METHOD RINSE AMOUNT <br /> I _ <br /> N RINSATE DISPOSAL SITE (, <br /> S <br /> E MANIFEST # - _ -OR- OTHER <br /> V VAPORS PURGED & N) METHOD AMOUNT USED <br /> A BGG <br /> P L. E. L. READING AT REMOVAL (MUST < 20-) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ,(STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIA S"fE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N f d Yw b i ac, /,?a� <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D S EXCAVATION SIZE: X X _ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P. L F' L u <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I -- — <br /> 0 H DEPTH TO G. W. FT SAMPLING METHOD <br /> N - - ---" - <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: C �/� �� SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23043 ( 10/89) DRAW SITE MRP ON REVERSE <br />