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PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />SITE NAME l"' <br />OWNER NAME <br />ADDRESSCITY S7p <br />OWNER PHONE # �c{op 1 345- 349 <br />CONTRACTORTA,yA�,5 r3crTc.31 <br />CONT. PHONE # _.777 <br />FIRE PERMIT <br />REMOVAL x CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR DATE 9�� ye{ TANK # 39 /ooV b <br />R <br />RINSED/ I) <br />METHOD <br />fir€ <br />R, <br />RINSE AMOUNT,��/ <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # OR OTHER <br />VA <br />VAPORS PURGED I) <br />METHOD �� r G C <br />AMOUNT USED <br />P <br />0 <br />READING AT REMOVAL <br />L.E.L.: O �� <br />02: <br />R <br />COMMENTS <br />C <br />0 <br />TANK MATERIAL STEEL, FIBERGLASS, OTHER) <br />N <br />S <br />TANK CONDITION (GOOD, OOR HOLES) <br />/�j <br />7 <br />T <br />PIPE MATERIALS EEL BERGLASS OTHER) <br /># FEET <br />PIPE CONDITION (GOOD, OR, HOLES) <br />T <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />A <br />/ 5A% SGr tr�aP �� ins ro e rr 3 caer <br />N <br />K <br />S <br />A <br />EXCAVATION SIZE X Sof X ^r2 <br />YDS OF SOIL /gyp <br />M <br />P <br />P <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />L <br />I <br />I <br />P <br />N <br />E <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />H <br />DEPTH TO G.W.: FT. <br />SAMPLING METHOD <br />2 <br />0 <br /># HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />LABORATORY:.,� <br />SAMPLERS NAME: G �ni42v£� <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />7 <br />