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PHS-EHD - UNDER <br /> (SHADED AREA TOBEppyy��FANK CLOSURE/ABANDON)o, INSF <br /> ED IN FO� R �T,THHE�yFIRST TANK ONLY) ON <br /> . OWNER �?:fli�ilv.Ji i.vf-fIIU"�7Ca`!;nw'7rr'�Yi.�L".'.11iJ.�i��Y.�ilrr� 'yrlyiYry �y <br /> E NAME _ ,.� - f` PP' <br /> E , . CONTRACTOR OWNER PHONE # <br /> R CON. _, <br /> SJLHD PERMIT # F'HONE#,/ .\ <br /> A <br /> LEPA # <br /> FIRE <br /> PERMIT <br /> INSPECTOR : '` i <br /> RRINSED (Y/N) TANK # _ <br /> I 9 _METHOD <br /> N RINSATE DISPOSAL <br /> S SITE RINSE AMOUNT <br /> E MANIFEST # <br /> V VAPORS PURGED (y/ -OR OTHER _ <br /> A N) METHOD -----_ <br /> F' L. E. L. READING AMOUNT USED <br /> 0 AT REMOVAL <br /> T R RE < 2C)X) <br /> COMMENTS <br /> N TANK MATERIAL (STEEL <br /> K C , FIBERGLASS, OTHER) <br /> / 0 TANK CONDITION (GOOD p TANK SIZE <br /> N , , OOR, HOLES) ; <br /> S PIPE MATERIAL (STEEL, FIBERS, OTHER) # FEET <br /> P T LAS0 <br /> I PIPING CONDITION (GOOD <br /> N , POOR, HOLES) <br /> G DEPTH SOIL TYPE <br /> T GRSEkVATION <br /> F - - SAMPLE # <br /> N <br /> L <br /> EXCAVATION SIZE: <br /> S -- X -..._ X <br /> A DEPTH SOIYDS OF SOIL: <br /> I L TYPE <br /> N M P OBSERVATION <br /> S P I SAMPLE # <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIME <br /> X --• X YDS OF SDIL <br /> 0 H DEPTH 'f0 G. W. <br /> N ---- FT SAMPLING METHOD <br /> OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> � 1 '_1 ( TCC&- IC, SAMPLERS NAME: <br /> CLOSURE IN GLRCE MIXTURE: ' <br /> V UL.UML <br /> 1 '23043 (10/09) DRAW SITE MAP ON REVERSE <br />