Laserfiche WebLink
PHS-EHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> �pl MAIr NHI- w.A-ImrBnf(/! !// <br /> v/ zaC"! 1//!!! <br /> w�rio <br /> ] <br /> A 6Y!/! Awvy&&Ifflw=Al,�� 1// <br /> OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR Tc CON. PHONE# <br /> E <br /> R SJLHD PERMIT # -177 EPA # FIRE ;PERMIT;*; <br /> A u <br /> L <br /> INSPECTOR DATE TANK # 39 - 4!9?"" <br /> R '_ RINSED ( <br /> Y/N) METHOD A)XtVb -7 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHODAMOUNT USED <br /> A by-) I <br /> P L. E. L. READING AT REMOVAL (MUST B�' ( 201A) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> T VA <br /> V <br /> L. <br /> 0 <br /> RCO <br /> 0 TANK CONDITION (GOOD, O HOLES <br /> N <br /> E MATERIAL (STEEL, FIBERGLASS, OTHER) # FEETa <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <br /> S p I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G. W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> I it <br /> L CLOSURE IN PLACE MIXTURE: <br /> MIXTURE: VOLUME: <br /> l <br /> :-H 23043 (10/89) DRAW SITE MAP ON REVERSE <br />