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PHS-*EHD - <br /> (SHADED AREA j%U TANK CLOSURE/ABANDON( <br /> ILLED IN FOR THE FR� <br /> ,ITNT $PECTION <br /> 6d-Aft UL I y- <br /> Yf <br /> NAME <br /> O Lrs�rin� <br /> E mok' -r,, - •o,�,rj�pr OWNER PHONE ' <br /> N CONTRACTOR -` 33 - 3S0 <br /> E Semty CON. PHONE# 52.4 7653 <br /> R SJLND PERMIT # :s�9ik� <br /> A EPA # FIRE PERMIT # <br /> L gr <br /> INSPECTOR 1DATE <br /> C• criv 1 ] �Q� TANK �* -39�- _1 <br /> R RINSED 6>N) METHOD <br /> I sSur'pA RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S J�'O <br /> E MANIFEST N J s <br /> -OR- OTHER <br /> VVAPORS PURSED Y/ ) METHOD <br /> A �r AMOUNT USED �s <br /> P L.-E. L. READING AT REMOVAL (MUST BE ( 2vX) <br /> ° n r•.�: <br /> T R COMMENTS .N <br /> A <br /> N TANK MATERIAL tSTEEL FIBERGLASS, OTHER) TANK SI <br /> K C <br /> O TANK CONDITi <br /> N (GOOD POOR, HOLES) <br /> S PIPE MATERIAL STEEL <br /> P T FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITI GOOD POOR, HOLES) <br /> N CR�str+c <br /> DEPTH SOIL TYPE 08SERVATION <br /> T SAMPLE # <br /> F A ' sra •N <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE:S .� X Q-•- X f6.. YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P "` SAMPLE # <br /> S P I <br /> P L P <br /> C N <br /> T G TRENCH D I MENS I ON -.... X X <br /> I YDS OF SOIL <br /> 0- H DEPTH TO a.W. FT <br /> N 2 SAMPLING METHOD <br /> 0 OF HOURS SIDE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME• <br /> CLO9URE IN PLACE MIXTURE: <br /> VOLUME: <br />:H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />