Laserfiche WebLink
PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />SITE NAME 1 , DRESS z� S �� ��� CITY 2` <br />W, LA <br />OWNER NAME OWNER PHONE # <br />CONTRACTORc o CONT. PHONE # <br />e� <br />FIRE PERMIT # <br />REMOVAL ✓ CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR a �ADATE �_ �6 9 Y TANK # 39 lYk 1 �z <br />F1R RINSED (9N) METHOD RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />rS <br />MANIFEST # OR OTHER <br />V <br />VAPORS PURGED ) <br />METHOD <br />i� <br />AMOUNT USED <br />A <br />P <br />READING AT REMOVAL <br />L.E.L.: Oo/D <br />02: Ute/ <br />0 <br />R <br />COMMENTS <br />C <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITIO (GOOD OOR, HOLES) <br />S <br />T <br />PIPE MATERIAL ST FIBERGLASS, OTHER) <br /># FEET O <br />PIPE CONDITIO (GOOD, POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />Irl oa�o/ /lo rc� ory n Z 5- <br />A A <br />N <br />pie L 1 sa <br />K <br />C u3 en <br />S <br />EXCAVATION SIZE _y� X X )3 <br />YDS OF SOIL <br />ASAMPLE <br />M <br />DEPTH SOIL TYPE OBSERVATION # <br />P <br />P <br />L <br />I <br />I <br />P <br />✓G `dn ✓ o ve <br />N <br />E <br />G <br />TRENCH DIMENSION X g — <br />YDS OF SOIL <br />DEPTH TO G.W.: FT.SAMPLING <br />METHOD r <br />H <br />2 <br /># HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: �POr✓'lq� �}c�� <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />I VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />