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PUBLIC AI:A.UXA U1V1J1UN t6- l'ov -� <br /> SITE NAME/)-7,j. RESTS F rs CITY <br /> OWNER gI <br /> N /� OWNER PHONE # <br /> CONTRACTOR NT._ PHONE <br /> R <br /> LC !� (�/tea.vHj <br /> FIRE PERMIT <br /> REMOVAL _ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> !NSPECTOR/�X / 4 DATE6_Z ,?VTANX 39 1530 — 0 / <br /> R RINSED Y ) MiTHOD 17 / /e- /fes j RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # 0 A 1,3 OR OTHER '/ <br /> V VAPORS PURGED /N) METHOD p,"p4-G r�//moo/ AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : (, 102: �, b <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STE , FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION((GOOD POOR, HOLES) <br /> S ' <br /> T PIPE MATERIAL (53EE FIBERGLASS, OTHER) Ir FEETLi �PEi <br /> PIPE CONDITION (GOO, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION ( SAMPLE <br /> T /. G✓i or S' <br /> Aa Si o <br /> N Al e e vrw o o <br /> X P 0 -A d- <br /> S EXC2VATION SIZE X (YDS OF SOILL 2�djj <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE if <br /> P P <br /> L I N 2 <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. / FT. SAMPLING METHOD <br /> H <br /> 2 if HOURS SINCE DEWATERING: Q <br /> 0 <br /> OTHER SAMPLE: — O A . I 6,4-0 <br /> LABORATOR 6r if /hob. CABs SAMPLERS NAME: <br /> CLOSURE PLACE MIXTURE: I VOLUME: 7-71F 30 <br /> �� <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br /> sia- 63�-d gsO <br />