Laserfiche WebLink
.i c� eivvlxvivinrivl'AL riPALTH DIVISION <br /> SITE NAMtF'lRtA W &.VLv ADDRESS c2 5'2 7y y/ CITY f}P,Vti1 i W Ca Tb! <br /> OWNER NAME TOWNER PHONE # <br /> CONTRACTOR CONT. PHONE A4 <br /> FIRE PERMIT 4 <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE _ <br /> INSPECTOR DATE'6-10 TANK 39 <br /> IRINS (Y ) METHOD �p RINSE AMOUNT, J <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 8R OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : d 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) J�GA094Q � i`e.� Z-'/ o lu- <br /> 0 TRnu <br /> N TANK CONDITION (GOOD, OOR, ttect — /VD• <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) f FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A <br /> K <br /> S EXCAVATION SIZE a_ X X 7 YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I 5 <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:'sic': i E <br /> Pap I <br /> LABORATORY:S1te/+w O o c. SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />