Laserfiche WebLink
FIHS--EHD - UNDERG*ND TANK. CLOSURE/ABANDONM* INSPECTION <br /> (SHADEDD AREA TO BEpy�FILLED IN FOR THE <br /> F�RST TAANNKL �ONLY) p <br /> "" <br /> �y IVY <br /> //a ,lfr `Ji��i7r, re rr Ir r <br /> E / <br /> OWNER NAME OWNER PHONE # �� / - � 3 -7 <br /> � <br /> N CONTRACTOR CON. RHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> i <br /> L <br /> INSPECTOR `GL. DATE 14 TANK. # 39 710, <br /> - -� ' -_ D <br /> . 77 <br /> R RINSED (Y/ METHOD / RINSE f1MOU <br /> I I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -_ -OR- OTHER <br /> I V <br /> A VAPORS PURGED Y IJ 7 METHOD f AMOUNT USEDf - <br /> _- <br /> P L. E. L. READING AT REMOVAL (MUST BE <br /> T R COMMENTS <br /> { Ar --- <br /> 1 N TANK, MA-rERIAL (STEEL, FIBERGLASS, OTHER) TANK, SIZE <br /> K. C - <br /> / 0 TANK CONDITION �D, 'OOR, HOLES) <br /> N �.—. <br /> S P IPE MATERIAL (STE'vL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G bEFITH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> 1 N of ri i67 <br /> E Krn <br /> L In 65 <br /> D EXCAVATION SIZE: X'-C X'-CX _ YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYRE OBSERVATION SAMPLE I# <br /> N M R <br /> S F' I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> 0 H DEPTH TO G. W. �- - F TSAMPLING METHOD <br /> N 2 - r <br /> 0 # OF HOURS SINCE DEWATERING: <br /> o OTHER SAMPLE: I av(kw <br /> LABCtRATORY: MC Lav, p.y� C SAMPLERS NAME: <br /> CLOSURE IN FLACE MIXTURE.. VOI_U1+1E: <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />