Laserfiche WebLink
1( K <br />PDBLIC DSVISION <br />SITE N22ME -C'LC ll2 <br />ADDRESS �CI 3 i W ! <br />' CITYS <br />047NE.4 42" �4 „eu-u-e— I <br />OWNEIR PHONE r <br />CONTR_iCTOR (CONT. <br />?HONE j <br />FIRE PERbLTT <br />R� OV?�L �OSLiL '`i PLACE T CRARY CLOSURE I <br />INSPECTOR �( DATE U <br />2'� ma rr r 39 <br />R <br />R.-NSED _/N) <br />! =HOD /r�i L2�RS �/ f R -VSE MIOUNT j <br />N <br />RLVSATE DISPOSAL SITE <br />S <br />E <br />Y-l-NT?EST r OR OTHER <br />i <br />V j <br />VAPORS ?URGED (I- .) � bSeTHOD \ CR <br />� MOUNT USLD <br />P <br />R=ING AT R_zMOVIL I L. L. _� ` 02: 3. U <br />0 <br />R I <br />COL"7IS <br />C <br />T A'T VAT-L'_AI <br />O <br />N ! <br />72.1N{ COND:TICN (GvOCD, COR HOLES) <br />S <br />v -mac r3Tt2_i (ST= , ?13LRGLASS, OTHER) <br />PIPE CONDITION (GOOD, ?CCR, HOLES) / <br />it <br />DEPT I So= T nE <br />OBSERVATION i SA.�LE T <br />T I <br />S t <br />_ <br />lbZ <br />A <br />i <br />I I 1 <br />I' <br />S j <br />�--=AVATION <br />SIZE I 3 <br />YDS OF SOIL <br />A <br />M <br />P <br />i <br />j <br />o <br />I <br />DOTH SO= TY -PE I CBSZRVA=ZON I SA.LpT F r <br />J I <br />L <br />I <br />I <br />P <br />I <br />I <br />G' <br />j <br />! <br />TR...MTC3 DnfE`7SION X I <br />I YDS OF SO= <br />i <br />I <br />2 <br />O <br />DEPTH TO G.7.: FT. I SAMPL.MG METHOD <br />r HOURS SINCEDE 7i A_^�_7 ING: <br />O, -=R SAMPT.E: <br />I <br />I <br />LABCRATORY: <br />! SAY-PT.c"RS NAS: <br />I <br />CLOSURE LN PLACEI T�T[JRE: <br />i <br />I VOL-uM": <br />= 23-0043 (REV 2/23/94) PROVIDE SITE M -AP <br />