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PHS-EHD - UNDERG41UND TANK CLOSURE - <br /> (SHA <br /> DED �jAREA �T/OBEF�yIILLrLED X,yNy� FOR/THENFIRSTN('ANKSONLY)ul� <br /> / �,y� wall <br /> , � <br /> rr "lr Ilffll rlv rr r�r ii�i�ii�irk <br /> OWNER NAME Sc� J yc ,F <br /> OWNER PHONE # <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R SJLHD PERMIT # � <br /> A EPA # FIRE PERt4I T # <br /> fy' <br /> INSPECTOR s DATE`?-. I q TANK # g - <br /> R RINSEDCY/N) - _�- <br /> I METHOI)._ � `RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE ' <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V VAPORS PURGED ( w" METHOD <br /> A c , AMOUNT USED `a <br /> F' L. E. L. READING AT REMOVAL (MUST BE ( Gi�;s) � LA y <br /> T R C©MMENTS <br /> A <br /> N TANK MATERIAL TE( , FIBERGLASS, OTHER) TANK SIZE <br /> c_ <br /> C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) ���� <br /> S PIPE MATERIAL 0-(STEL, FIBERGLASS,.P T �THER� # FEET <br /> I PIPING CONDITION (GOODI POOR, HOLES) / f <br /> G �y�iJr ij V �Lx7� 1 g2PJLFf2C�G�✓L SLC} <br /> DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L7 - <br /> D EXCAVATION SIZE: 3-1 X r <br /> S , X L-2 YDS OF SOIL: <br /> I A DEF-TH SOIL TYPE OBSERVATION <br /> N M P SAMPLE <br /> S F I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I --- X -4 _._ XYDS OF SOI L <br /> O H DEPTH TO G. W. : <br /> N ______��-_-. FT SAMPLING METHOD <br /> # OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: p}f <br /> 1 "' SAMPLERS NAME: <br /> 11 CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> DRAW SITE MAfD ON REVERSE <br />