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PUBLIC VEALTH SERVICES-ENVIRONMENTT - HEALTH DIVISION <br /> SITE NAME ADDRESS r�( L./ CITY 5 <br /> L <br /> NAME /JOWNER PHONECTOR CONT. PHONEERMIT # 9tL�AL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> 2 <br /> INSPECTOR DATE a �� TANK # 39 /SDS - D 3 'DOD iLail <br /> JR RINSED Y N) RINSE AMOUNTRINSATE DISPOSAL SITEMANIFEST # OR OTHER <br /> V VAPORS PURGED Y N) METHOD /"--fAMOUNT USED �� <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION GOOD, POOR, HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, IBERGLASS OTHER) # FEET 2�0 <br /> PIPE CONDITION GO D POOR, HOLES - alQ �j E�jGL4A:,ct,Q <br /> DEPTH SOIL TYPE OBSERVATION W-e-� SAMPLE # <br /> T Z / ' �f5'✓ <br /> A <br /> N <br /> K .z TSS 9 <br /> at <br /> S EXCAVATION SIZE X X /Z YDS OF SOIL t <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I z <br /> I P <br /> N E <br /> G 6 <br /> Ll TRENCH DIMENSION 3' X (p X ( 2.' YDS OF SOIL <br /> DEPTH TO G.W. : -(-32-• FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <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 />