Laserfiche WebLink
PHS-EHD - UNDERGIIND TANK CLOSURE/ABANDONME6 INSPECTION <br />(SHADED AREA TO BE FILLED IN FOR THE FTRftT Toniu n1l,.1 <br />EF <br />a-043 (10/89) <br />DRAW SITE MAP ON REVERSE <br />OWNER NAME <br />OWNER PHONE # <br />E <br />N CONTRACTOR <br />CON. PHONE# <br />E <br />R SJLHD PERMIT# EPA # -, FIRE PERMIT # -e-(( 6�• <br />A .G7 <br />¢ k <br />L <br />INSPECTOR: <br />DATE <br />RI <br />RINSED ( /N) <br />METHOD <br />RINSE AMOUNT <br />N <br />RINSATE DISPOSAL SITE c{ S} ,� a.,,���n�(SC� <br />S <br />E <br />MANIFEST # -OR-OTHER <br />AV <br />VAPORS PURGED '(Y/N) <br />METHOD <br />AMOUNT USED <br />L.E.L. READING AT REMOVAL (MUST BE ( OUX) Ole �0 0 <br />P <br />0 <br />T <br />A <br />R <br />COMMENTS j �LpiV� A6PRoYAc-- <br />N <br />K <br />C <br />TANK MATERIAL ( TEEL FIBERGLASS, OTHER) TANK SIZE <br />/ <br />0 <br />TANK CONDITION (GOOD, OOR, HOLES) <br />N <br />S <br />F'IF'E MATERIAL (STEE , FIBERGLASS, OTHER) <br /># FEET J2n F r <br />P <br />T <br />PIPING CONDITION (GOOD, OOR, HOLES) o�YpS(sy- P1idp <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />T <br />F <br />A <br />�J <br />— <br />I <br />N <br />E <br />K <br />N© NO 7t q..j <br />f-2° <br />T <br />L27 <br />- <br />D <br />EXCAVATION SIZE: _4 X yZ X YDS OF SOIL: <br />S <br />I <br />A <br />DEPTH SOIL TYPE <br />OBSERVATION }O P p SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />I <br />G <br />TRENCH DIMENSION - X _ X <br />-- — <br />YDS OF SOIL �- <br />0 <br />N <br />H <br />DEPTH TO G. W.: :`„��;-< FT <br />SAMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: , <br />SAMPLERS NAME: Mil <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EF <br />a-043 (10/89) <br />DRAW SITE MAP ON REVERSE <br />