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PUBLIC HEA- 'H SERVICES-ENVIRONMENTAL H`NLTH DIVISION <br /> FECONTRACTOR,,_� <br /> ME bG � �'( ADDRESS �rQL r.'2Ci�o CITY <br /> AME eu OWNER PHONE <br /> CONT. PHONE # Z0 <br /> FIRE PERMIT # <br /> REMOVAL_x CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE ;IfI TANK # 39 10002- cl I U <br /> RINSED (Y)N) METHOD �fvv Qy�q RINSE AMOUNT 7Q;o �_ <br /> SRINSATE DISPOSAL SITE �p_ <br /> E MANIFEST # / o �j 3V��j� OR �+OTHER <br /> V VAPORS PURGED ON) METHOD 4Ce AMOUNT USED.C, <br /> A <br /> P READING AT REMOVAL L.E.L. : < 02 : A07- �� �Lq <br /> O <br /> R COMMENTS — � ,tb, Do&LA ('15r— I <br /> C TANK MATERIAL STE , FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION GOOD POOR, HOLES) Ale) u9 <br /> S <br /> T PIPE MATERIAL (STEEL IBERGLASS, OTHER) # FEET, 5-00 f <br /> PIPE CONDITION (GOO , POOR, HOLES) 14ea - <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A15, A)O iva <br /> N at t a i Ca+ t <br /> K <br /> S EXCAVATION SIZE %V X X / YDS OF SOIL t � <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I <br /> I P <br /> N E <br /> G r� <br /> TRENCH DIMENSION Z X 2Y2 XYDS OF SOIL <br /> DEPTH TO G.W. : 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 />