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PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEAVIi UIV1A1ViV <br /> SITE NAME Cp ADDRESS 27. s, �� "^� CITY <br /> OWNER NAME s', ,J ,C,j, 5 OWNER PHONE <br /> CONTRACTOR CONT. PHON <br /> FIRE PERMIT # �' - Z/iU ( 5'n ?- 7ip�6 <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR . DATE TANK # 39 2-3 <br /> R RINSED (Y N METHO li/a �t RINSE AMOUNT :5noo <br /> I C � <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED (YAO METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : o. 02: /Z <br /> 0 <br /> R <br /> COMMENTS �iyiu <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION 4GOOD, POOR, HOLES) <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 <br /> N <br /> K <br /> S EXCAVAT �)6 X l3 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 N/1 X X YDS OF SOIL <br /> DEPTH TO G.W. : '?, FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: ,V <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />