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PHS-EHD - UNDERGROUP' TANK CLOSURE/ABANDONMENT 'SPECTION <br /> (SHADED AREA <br /> lu� r yT�yO� yBLL,.w''IpyL�yLryEyDy�yIN FOR THE FIRST 7 <br /> "liJ1iY]L7u�"ILrrl7l LluiIILILIL r F� ONLY) <br /> NA !' /S L r <br /> i� , < OWNER ME <br /> E OWNER PHONE # <br /> E CONTRACTOR CON. PHONE# <br /> A <br /> Y <br /> -� -z� - <br /> R .F SJLHD PERMIT # <br /> A N EPA # /�rCYi�n ; . FIRE PERMIT # <br /> /. , <br /> r „ � �,y�� 1�'I x'11 - 023 / � <br /> INSPECTORuN DATE 3171 TANK # -29 <br /> R RINSED (Y N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S o k ��u/v alas t7 <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED lY N) <br /> A METHOD i AMOUNT USED <br /> P L. E. L- READING AT REMOVAL (MUST BE <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIDERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDI TI (GOOD POOR, HOLES) <br /> �P <br /> N tc r �u� Nr <br /> S PIPE MATERIAL (STEEL, FIBERGLAS OTHER) # FEET <br /> P T te: <br /> I PIPING CONDITION (GOOD, POOR, HOLES) v � ' <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION F SAMPLE # <br /> Aion _r-. �y <br /> I N /o- <br /> K /o- ieN �x2 <br /> sk <br /> S <br /> D PL <br /> EXCAVATION SIZE: x L x YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> V M p SAMPLE # <br /> P I <br /> ' L P <br /> I E <br /> N <br /> G TRENCH DIMENSION <br />• x <br /> H DEPTH 70 G. W. <br /> I FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: CPN JN iprr� <br /> VOLUPIE: <br /> x2043 ( 10/ag) DRAW SITE MAP ON REVERSE <br />