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PUBLIC HLsTH Sr'"2iVV"S-EYVIRONMPar IT?>.L ,,ALTH DIVISION <br /> SITE -NAMEfLIJ�k r (ADDRESS 70'f CITY s <br /> TOWNER NAME TOWNER PHONE € <br /> CONTRACTORC-.4:7Lp I CONT. PHONE <br /> FIRE PERMIT r <br /> REMOVAL CLOSIIRE PLACE T�EM.PCRARY CLOSLRE <br /> INSPECTODATE j T-LV r 39 5 �Z <br /> R RINSED (Y N) x TROD R-TNSE AMOUNT Zi7,7 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S OR OTHER <br /> E MANxFEST � <br /> V VAPORS PURGED DJN) jm:ETHOD -�t- (AMOUNT USED 3?.0//j <br /> pp, I 3 <br /> READING AT R..7MOVAL L.?.L. : 02: <br /> 0 <br /> R COMMENTS <br /> C TANK MAT—RxAL ( nBMGLASS, OTHER) <br /> 0 /I <br /> N TA.Nx CONDITION (GOOD, _OOR OLES (nu�eo w� V4k, (A-y P <br /> SM <br /> T vxpE MA'TRT�L (STEEL, FI3E.RGLASS, OTHER) r FEET <br /> PIPE CONDITION (GOOD, PCOR, HOLES) <br /> DOTH SOIL TYPE I OBSERVATION I SAMPLE r <br /> T I i _ o rwr I S — <br /> I v <br /> � I <br /> I I s I <br /> S EXCAVATION SIZE S % YDS OF SO= <br /> A <br /> M DEPTH SOIL TYPE IOBSERVATION ISAMPLE r <br /> D D <br /> L I <br /> I P I I <br /> N E I <br /> G <br /> TRmic3 D=SION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. ( SAMPLING VmTHODGr <br /> H <br /> 2 T HOURS SINCE DEWATr...2LYG: a <br /> 0 <br /> OT3:."R SAMPLE: <br /> i 0 - <br /> LABORATORY: � � I SAM.PT-22 NAME: }Z <br /> CLCSURE IN PLACr_ I ml crDRE: I VOLUME: <br /> ""ZH 23-0043 (RE-7 2/23/94) PROVIDE SITE MAP <br />