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SITE NAME <br />ADDRESS <br />CITY <br />OWNER NAME `"' o ' "," <br />OWNER PHONE # <br />CONTRACTOR '"` <br />CONT. PHONE # <br />FIRE PERMIT <br />REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR DATE �j/i3/C�(o TANK # 39 i S UCU <br />R <br />RINSED -�&/N) <br />METHOD <br />RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # OR .OTS <br />V <br />A <br />P <br />0 <br />R <br />VAPORS PURGED GYl/N) METHOD ��, C� AMOUNT USED J <br />READING AT REMOVAL L.E.L.: 02: 0 <br />COMMENTS <br />C <br />TANK MATERIAL (( TEEL) FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION (GOOD, POOR, y HOLES <br />i -r- r •, >s aS C, d <br />S <br />T <br />PIPE MATERIAL TEEL,)FIBERGLASS, OTHER) <br />� <br /># FEET S <br />PIPE CONDITION (GOOD, POO , <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />A <br />K <br />S <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />A <br />M <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />P <br />P <br />L. <br />I <br />I <br />P <br />N <br />E <br />G <br />TRENCH DII+D;NSION X X <br />YDS OF SOIL <br />H <br />2 <br />0 <br />DEPTH TO G.W.: FT. <br />SAMPLING METHOD <br /># HOURS SINCE DEWATERING: <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 />