Laserfiche WebLink
PUBLIC HEA 3 SERVICES-ENVIRONMENTAL H LTH DIVISION <br /> SITE NAME psi S�C�r ADDRESS 1 2!S N a� «6��o J CITY <br /> OWNER NAME OWNER PHONE # <br /> CONTRACTOR CONT. PHONE # <br /> FIRE PERMIT # <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK # 39 isz� i <br /> R RINSED (VN) METHOD RINSE AMOUNT 'q 2' <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED ( N) METHOD �� �� AMOUNT USED <br /> P READING AT REMOVAL L.E.L. : p`0 p 02 : 1� p <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIALTE FIBERGLASS, OTHER) <br /> 0 _ <br /> N TANK CONDITION (GOOD, POOf2 HOLES) Cv rosttr �o o ,t k Ls <br /> S <br /> T PIPE MATERIAL (ST E FIBERGLASS, OTHER) # FEET IO <br /> PIPE CONDITION (GOOD, O R HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A <br /> N Cl lK- <br /> K / K <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A 11 <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I uw o <br /> I P <br /> N E i <br /> v <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : kZ- tS 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 />