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PHS-EHD - <br /> 1D TANK CLOSURE/ABANDON <br /> UNDEQCBE <br /> (SHADED AREA FILLED IN FOR THE FIR INSPECTION' <br /> RST TANK ONLY) <br /> ooG. C�' <br /> E <br /> OWNER- NAME cor <br /> K� <br /> wOdLSe oll _ OWNER PHONE # <br /> N CONTRACTOR <br /> E N CON. PHONE# <br /> R SJLHD 09RMIT # <br /> A # FIRE PERMIT <br /> INSPECTOR <br /> DATE 39 ,- <br /> R RINSED Y N) <br /> I METHOD <br /> N RINSATE DISPOSAL SITE RINSE AMOUNT <br /> S �'hd <br /> E MANIFEST # <br /> --OR— OTHER <br /> V VAPORS PURGED } <br /> A METHOD <br /> ';�cG AMOUNT USEDXf <br /> P L. E. L. READING AT REMOVAL <br /> 0 (MUST BE ( Epx} <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER} TMOAM <br /> K C TANK SIZE ��// <br /> / 0 TANK CONDITION GOOD, POOR, HOLES) <br /> 7 aDd. GSL <br /> N /77�16,t a L. <br /> _ S PIPE MATERIAL (STEE <br /> P T FIBERGLASS, OTHER) # FEET <br /> I PIPING COPIDITLION (8OOD, POOR, HOLES) <br /> N • <br /> G DEPTH SOIL TYPE <br /> T OBSERVATION <br /> F SAMPLE # <br /> A 11,7.'Vayt CG <br /> I N � I c <br /> E K aiN o p ti <br /> L <br /> D EXCAVATION SIZE: 2! X <br /> S X YDS OF SOILS <br /> I A .:.: ., <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I SAMPLE # { <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. s <br /> N 2 ____—,—� FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> r. <br /> LABORATORY: dA tv If <br /> �— <br /> =Milln SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTUR <br /> VOLUME: <br /> EH 23043 (10/89) DRAW SITE MAP ON REVERSE <br />