Laserfiche WebLink
PHS-EHD - UNDERGROL;, TANK CLOSURE/ABANDONME''T,�SPECTION <br /> (SHADED AREA T ' FILLED IN FOR THE FIRSI�DK ONLY) <br /> OWNER NAME <br /> E OWNER PHONE <br /> N ! CONTRACTOR M� j� 76 i <br /> E ✓ CON. PHONE# - /��/ S/ y <br /> R SJLHD PERMIT # Gop �� 6 . o '/ <br /> A ' "y' = ,✓• r , �,,, yy FIRE PERMIT # 6 <br /> L <br /> J <br /> INSPEC 0 DATE 3 <br /> . TANK # <br /> R RINSED Y N) METHODL� <br /> I /`7Z< j,/� RINSE AMOUNT �Z <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> `V VAPORS PURGED Y N) METHOD <br /> A AMOUNT USED <br /> P i <br /> L.E. L. READING AT REMOVAL (MUST BE ( 20%) LSV �tivv <br /> 0 <br /> T R COMMENTS u <br /> N TANK MATERIAL (STEE FIBERGLASS, OTHER) TANK SIZE K C O v <br /> / 0 TANK CONDITION (GOOD, POOR, HOLE <br /> N oo s <br /> S PIPE MATERIAL ;STEEL , OTHER) # FEET <br /> P S FIBERGLASSI <br /> I PIPING CONDITION (GOOD/ POOR, HOLES) 4-ole-s. <br /> O/eS <br /> N <br /> G DEPTH SOIL TYPE OBSER !�VATION a/fi¢ <br /> F T SAMPLE # <br /> I . N eU. <br /> L <br /> D +I EXCAVATION SIZE: <br /> S X g X Z YDS OF SOIL: �S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P 5iL v o e o i IiJ <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. : / <br /> I N -----L�-____ FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: ✓ <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: L-LCs-- N <br /> VDLUPIE <br /> 1 22043 (10/89) DRAW SITE MAP ON REVERSE <br />