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PHS-EHD - UNDEF&UND TANK CLOSURE/ADANDONIM NT I <br /> (SHADED AREA TO BE FILLED IN NSF'ECTION <br /> � ��;/ FOR THE FIRST RST TA�N�K ONLY) <br /> /, f �;�/,,f��yy��(--�//(��4CV �/ � 1 <br /> `! OWNER NAME r �j� OWNER PHONE # <br /> N e CONTRACTOR F -, F` 3 r 373 c f <br /> E /�jfJ r' CON. PHONE#( oZ(7 j n7 y 1-4 i/ <br /> R % SJLHD PERMIT # �? J`�,3 <br /> A EF'A # <br /> LFIRE PERMIT # <br /> CC ` • / , �/ f <br /> C / <br /> INSPECTOR <br /> P; DATE � �� TANK # 39 - Q <br /> R RINSED , ,,.f, ;, ' - L—•-�`-f _. <br /> Y/N) METHOD ,�� <br /> 1 R I N.,E AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -QR- OTHER <br /> V VAPORS PURGED (Y/N) �y - ~ <br /> A NEI-HOD AMOUNT USED <br /> F' L. E. L. READING AT REMOVAL (M <br /> 0 UST BE <br /> T R COMMENTS L` � <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS <br /> K C , OTHER) TANK SIZE F <br /> / O TANK CONDITION (GOODS C <br /> N ',.-`FDClR, HOLES) 1 <br /> • S F'IF'E MATERIAL (STEEL, FIBERGLASS ''L•[.� I•Pc� �, ,. � , �� ' �� <br /> P T , 0' R) # FEET <br /> I PIPING CONDITION (GOOD <br /> N , POOR, HOLES) <br /> c' DEPTH c <br /> T SOIL TYPE OBSERVATION <br /> F A 5 ' SAMPLE IF <br /> I N k <br /> E K r <br /> L <br /> D EXCAVATION SIZE; <br /> S X — X YDS OF SOIL: <br /> I A DEPTH SQIL TYPE <br /> N M P OBSERVATION <br /> SAhIF'LE ## <br /> S F' I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> O H DEPTH TO G. W. : <br /> N ? --------- FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> O ©THEIR SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 03443 ( 14/89) DRAW SITE MAP ON REVERSE <br />