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PHS--EHD — UNDERGf .N'i] TANK CLOSURE/ASANDONME� , -iov"4PECTLON <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY <br /> ;� j LUlllfaYV1 i��Ti�JGJ'dYf/!!O/A!!/11!!!!!l/flff!/!!/Lll1dUV/ULOJ!/J6'/ MOMS' , 0Jdlf/ !lllY!iUJ!/1D <br /> i OWNER NAME OWNER PHONE # <br /> •r <br /> N CONTRACTOR CON. PHONE* <br /> f c <br /> R SJL PERMIT # f A' EPA # ZLO FIRE PERMIT <br /> L i : � use tri N N c <br /> i <br /> INSPECTOR j� Lr DATE J�(� TANK # 3S — — 06 4 <br /> � 4 <br /> R1 RINSED (Y N) METHOD PC RINSE AMOUNT P <br /> I I <br /> i <br /> RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # RZZ�, l09 _ --OR— OTHER <br /> V NABOBS PURGED C / ? METHOD �,�I Q . AMOUNT USED 4?�0'4, r <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20X) L -O �Z <br /> 0 n� <br /> T R 4 COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS OTHER) TANK SIZE f�� <br /> K C { <br /> 1 0 F TANK CONDITIO (GOOD POOR, HOLES) <br /> N <br /> PIPE MATERIAL (STEEL, IBERGLA , OTHER) # FEET <br /> i P T <br /> I j PIPING CONDITION ( OO , POOR, HOLES) Wi �f WAf\ <br /> N , ' <br /> { G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> FI A <br /> I N t O or <br /> 1 .7 <br /> ' J <br /> E K <br /> L I <br /> D EXCAVATION SIZE: `-' X X YDS. CF SOIL: <br /> S <br /> 5 I A RTRENIC <br /> TH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S II P I 44 qqLAM <br /> i. P I (- P � 1 <br /> rE I E <br /> C N <br /> T G H DIMENSION X X YDS OF SOIL <br /> I f s <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> I 0 + # OF HOURS SINCE DEWATERING: � <br /> O OTHER SAMPLE: f <br /> { <br /> LABORATORY: �� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: 1 <br /> ''zH 23443 ( io/$9) DRAW SITE MAP ON REVERSE <br />