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PUBLIC HEAL SERVICES—ENVIRONMENTAL HF TH DIVISION <br /> SITE NAME PAC j3 ELkIADDRESS / ) 3 T3c(�aY�Si. CITY <br /> OWNER NAME OWNER PHONE # <br /> CONTRACTOR (CONT. PHONE # <br /> FIRE PERMIT # 24— <br /> REMOVAL_ CLOSURE IDN PLACE TEMPORARY LOSURE <br /> INSPECTOR77_' DATE II_' b—�j TANK # 39 /` (�— <br /> R RINSED (,(YA) M=OD ftIJ J �w� RINSE AMOUNT <br /> I N <br /> SRINSATE DISPOSAL SITE ►u /+ T <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED.(Y N) METHOD DRY AMOUNT USED A5 /hS <br /> A <br /> P READING AT REMOVAL I L.E.L. 02: Tj i <br /> 0 <br /> R COMMENTS <br /> C TANX MATERIAL STE FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD 00 HOLES) 1 1 +4 /%p Hsi I7 IG hdP� ti <br /> S <br /> T PIPE MATERIAL STE FIBERGLASS, OTHER) T# FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> E = - a�✓Q <br /> DEPTH SOIL TYPE OBSERVATION_ g[? -7SAMPLE # <br /> T <br /> A <br /> N S v'L e — <br /> K — S <br /> S EXCAVATION SIZE X T XYDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATIONS # <br /> P P I D <br /> L I ( . <br /> I P Linp <br /> N E <br /> G <br /> TRENCH DIMENSICH X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHQD «,(y S <br /> H <br /> 2 # HOURS SINCE DAATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: �a,b SAMPLERS NAME: I,,-&, <br /> CLOSURE IN PLACEXTURE: �� 753-ys� VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />