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PHS-EHD - UNDER : <br /> X10 TANK CLOSURE/ABANDON <br /> (SHADED AREA <br /> BE FILLED IN FOR THE FIRS TANK�Y)ON g'-r <br /> V�/oOLsF L N .. <br /> OWNER NAME -s <br /> E hoo Gse (�,'(, OWNER PHONE # p <br /> N CONTRACTOR <br /> E CST S I}' CON. PHONE# 0/_ .3P7 ' <br /> R SJLHD PERMIT # 2oz5 <br /> A F.1RE PERMIT # <br /> L <br /> I NSPECTO DATE �� �� TANK # 39 - <br /> R RINSED (Y/N} METHOD <br /> I ,Pj Le �,;,�5� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE •s. <br /> S SGa., <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED /N) METHOD <br /> A AMOUNT USED <br /> P L. E. L. READING AT REMOVAL (MUST BE < 2dX} <br /> O D , <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C OD <br /> / 0 TANK. CONDITION ( POOR, HOLES) AL10 .. 04 <br /> N <br /> S PIPE MATERIAL ((STEgLFIBERGLASS9 OTHER) # FEET <br /> P T <br /> I PIPING CONDITION t000D <br /> N POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE <br /> F A e a o 0 <br /> I N o <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> 1 A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S P 1 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: lj Gl-�i SAMPLERS NAME: ✓01G <br /> CLOSURE INPLACE MIXTURE: <br /> VOLUMES <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />