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PUBLIC HE,t,itH SERVICES-ENVIRONMENTAL h iTTH DIVISION <br /> SITE NAME aX&e*_� 0/Z3 ADDRESS /D 3 7 :5. 1CITY <br /> OWNER NAME a4o&zj IOWNER PHONE # <br /> CONTRACTOR Aetn.r,,, ICONT. PHONE <br /> FIRE PERMIT # NO :i4 - o <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE ��Z(, 91p TANK # 39 <br /> R RINSED �Y ) METHOD /C RINSE AMOUNT !� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> TA VAPORS PURGED Y�27) METHOD /icJL_- AMOUNT USED /5'`£ x <br /> READING AT REMOVAL L.E.L. : 0 02 :COMMENTS <br /> C TANK MATERIAL STE , FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, POOR, HOLES <br /> S <br /> T PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T f k cndn e7 (A ua(ire a1r` - <br /> A <br /> N <br /> K <br /> S EXCAVATION SIZE IZ X 0g X YDS OF SOIL :ZS eh <br /> A <br /> M DEPTH I SOIL TYPE OBSERVATION SAMPLE <br /> P P _ c <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION 7' X X YDS OF SOIL <br /> DEPTH TO G.W. : 13 FT. SAMPLING METHOD „QR �pK <br /> H <br /> 2 # HOURS SINCE DEWATERING: lf(A- <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />