Laserfiche WebLink
PHS-EHD - UNDE OUND TANK CLOSURE/ABANDO T INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE FIR ' TANK ONLY) <br /> OWNER NAME OWNER PHONE <br /> # <br /> Wiz. /i d z <br /> E Sa3- i9o� � <br /> N CONTRACTOR '���`'�i' %�i�r�zc CON. PHONE# <br /> E <br /> R SJLHD T,T # EPA # FIRE PERMIT # N/ <br /> L y , <br /> PECTOR DATE 5/2�,/, TANK # 39 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OT R _ <br /> AV VAPORS PURGED (Y/N) MET -O J A�dUNT USED <br /> P L. E. L. READING AT EMOVAL ( UST B r ( 06 tri'" <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL OT <br /> (STEEL, FIBERGLASS, HER) TANK SIZE <br /> K C sw • - <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N ' r'� '.. 6✓ o elm- - a 1: -f'� <br /> E K <br /> L <br /> 0 EXCAVATION SIZE: X 7 ' <br /> S X wiz YDS OF SOIL: <br /> — <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCHDIM SION <br /> I ____ X X YDS OF SOIL <br /> - <br /> 0 H DEPTH TO G. W. : FT <br /> N 2 SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN GLACE MIXTURE: <br /> VOLUhIE <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />