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SITE NAME i� �� <br />ADDRESS <br />CITY <br />OWNER NAME <br />OWNER PHONE <br />CONTRACTOR -. { '"' <br />CONTRACTOR, <br />CONT. PHONE <br />FIRE PERMIT <br />REMOVAL r, CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR - <br />DATE `'; i TANK # 39 <br />R <br />I <br />RINSED '/T) METHOD <br />11-Y I <br />_ RINSE AMOUNT <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # <br />OR OTHER <br />V <br />VAPORS PURGED Ct/N) <br />METHOD „•- J� AMOUNT <br />A <br />P <br />READING AT REMOVAL <br />L.E.L.: 02: <br />O <br />R <br />COMMENTS <br />C <br />TANK MATERIAL `STEEL' <br />FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION (GOOD, <br />i 00R, HOLES) <br />S <br />T <br />PIPE MATERIAL'(STEEL; <br />FIBERGLASS, OTHER) <br /># FEET :> µ- <br />PIPE CONDITION (GOOD,�,POOR, HOLES) :y - <br />DEPTH SOIL TYPE <br />OBSERVATION SAMPLE # <br />TA <br />r• r <br />C'C; <br />N <br />r <br />K <br />EXCAVATION SIZE <br />X X <br />YDS OF SOIL <br />S <br />A <br />M <br />DEPTH SOIL TYPE <br />OBSERVATION SAMPLE # <br />P <br />P <br />N <br />E <br />G <br />TRENCH DIMENSION <br />X X <br />YDS OF SOIL <br />DEPTH TO G.W.: <br />FT. <br />SAMPLING METHOD <br />H <br />2 <br /># HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />