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PUBLIC H "TH SERVICES-ENVIRONMENTAL tT FTH DIVISION <br /> SITE NAME ADDRESS J3-,,-,4,.� W CITY <br /> OWNER NAME � ifA�CEQ OWNER PHONE � 3q5 3sg <br /> CONTRACTOR-yA, r3k _�� CONT. PHONE # (2�� 45�� _ 779 <br /> FIRE PERMIT �7c/l'6 <br /> REMOVAL X CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE 91,,/ 9�/ TANK # 39 /ooV <br /> R RINSED ((Y/N) =HOD—/—,-P,p RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITEviea�� cvE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Z N) METHOD �j� AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : Z % 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL " TEFL,--FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, J0—OR,--HOLES) Zg j C--lo <br /> S <br /> T PIPE MATERIALTE=, SMOTHER) # FEET , 3�KSES <br /> PIPE CONDITION (GOOD,, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A F Z--All /do 000.2 o SciL rLCL' i 7'04 +' <br /> N <br /> K <br /> S EXCAVATION SIZE 6 X X ^ S YDS OF SOIL + 6 <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: v�GE'e <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />