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PUBLIC HEAha.VE SERVICES-ENV'IRORMFMXL g&TH DIVISION <br /> SITE NAME (ADDRESS 7500 CITY <br /> OWNER NAME i L I OWNER PHONE Cao q) 50,3440 —33 g� <br /> CONTRACTOR Dm *,U ICONT. PHONE € <br /> FIRE PERMIT c I . <br /> R.jMOVAL_,2� _ CLOSURE 1121T PLACE TEMPORARY CLOSIIR.S <br /> -_NSPECTOR Q h a! 5 DATE ,,f=� 99 TANK # 39 5b �� <br /> R RINSED (Y N =HOD TIDY 1C I PSE AMOUNT <br /> I <br /> N R-WSATE DISPOSAL Sl- <br /> =-S <br /> E MAN--=EST # OR OTHER <br /> AP <br /> V VAPORS PURGED (Y,® I ME±'HOD TfI fU K-F i"- =1 S/g01 L' _ -0USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: <br /> 0 <br /> R Colen rS sct"nC 2' <br /> C TANK MATER= (sTE FIBERGLASS,'T <br /> 0 <br /> N TANK CONDITION (GOOD, OOR HO=S) <br /> S <br /> T PIPE MAS - (STEEL, FIBERG:A.SS, OTHER) I # FEET <br /> PSE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH I SOIL, TY'PE I OBSERVATION I SAMPLE r j <br /> T <br /> I I <br /> N I 1 <br /> K <br /> I � <br /> S EXCAVATION SIZE % _ % (YDS OF SOIL <br /> a <br /> M DEPTH ISOIL TYPE OBSERVATION SAMPLE r <br /> P <br /> L - I I I <br /> I P <br /> N EI <br /> G <br /> TRENCH DIMENSION % X YDS OF SOIL <br /> DEPTH TO G.A. : FT. SAMPLING METHOD <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 _ �` S <br /> OTHER SAMPLE:.7t'U 36 JYR (� I�LtFt �{d S <br /> LABORATORY: S AAh w ars I SA*L�Lr RS NPM G A ns L 5 <br /> CI CSuRE IN PLACE *!-XTRs E: I VOLUY-?: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />