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'PHS-EHD - UNDERGRO TANK CLOSURE/ABANDONMENT SPECTION <br /> (SHADED AREA TO ILLED IN FOR THE FIRST ONLY) <br /> l ��m��lvlrl���la>Q�aarJuraurrvra>aurra�rruiarav�auaucrrwur>a���{�!!!i r�t 5��ara�irirYra>ara >,v>u>uia r�rr>�u�.ul���ia>1i�l�I/iu.tiiucv <br /> i OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> i L <br /> I INSPECTOR ,I DATE <br /> J�.� �� TANK # 39 - ;<��a -s 97 Qrrado - 65— <br /> I <br /> R RINSED ( ( N) METHOD � <br /> I 5�.11 N05 RINSE AMOUNT CO I <br /> I N RINSATE DISPOSAL SITE <br /> I S �Pr•v/GPs rS�N <br /> I E MANIFEST # -OR- OTHER <br /> i <br /> V VAPORS PURGED (Y ) METHOD AMOUNT USED 20 i <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) d <br /> d <br /> O 0 <br /> T R COMMENTS j <br /> A <br /> N TANK MATERIAL ( TEE , FIBERGLASS, OTHER)_ . TANK SIZE. <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) T# FEET /U <br /> P T i <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A Or n>o Isco as <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 4cX /c, X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br />' C N <br /> T G TRENCH DIMENSION X X --TYDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> n OTHER SAMPLE: <br /> r j <br /> LABORATORY: W PS SAMPLERS NAME: Q <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 1 <br /> H 23043 (10/89) DRAW SITE- MAP ON REVERSE <br /> I <br />