Laserfiche WebLink
PUBLIC HEP- 'H SERVICES-ENVIRONMENTAL H" LTH DIVISION <br /> SITE NAME 4 0PPSC.O ADDRESSj/ g�J <br /> OWNER N�A5T',6 OWNER PHONE f <br /> CONTRACTOR _ CONT. PHONE (��, f ! - RT j 7 <br /> FIRE PERMIT I f <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE ��-I r 9� TANK # 39 5D fJrOS <br /> R RINSED ) METHOD RINSE AMOUNT/6 aO' <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED `(YJN) (METHOD 4)Q_4SGL AMOUNT USED <br /> A <br /> P READING AT REMOVAL ( L.E.L. : A._ 02 : <br /> O <br /> R COMMENTS <br /> C TANK MATERIALSTEEL,)FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, POOR HOLES 1° - - <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A +. S <br /> N <br /> K <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I <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 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: S�h LV-'tvcj - SAMPLERS NAME: -1) S ��o S <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />