Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> SITE NAME �� hll4� ADDRESS "T 5 J/ CITY <br /> ii OWNER NAME H ,ji (OWNER PH/ONE a' ry <br /> CONTRACT GG.� , CONT. PHONECa�� if(PLj -9333 <br /> FIRE PERMIT f q5_ 175 <br /> 5 <br /> REMOVAL_X CLOSURE IN PLACE Gam\ TEMPORARY CLOSURE <br /> INSPECTOR ef'+�e�' DATE TANK # 3 9 <br /> J <br /> IRINSED . Y N) METHORINSE AMOUNT410 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 0 OR OTHER <br /> V VAPORS PURGED . O N) (METHOD AMOUNT USED <br /> A - <br /> P READING AT REMOVAL L.E.L. : �� 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, OOR HOLES) L <br /> S eT <br /> T PIPE MATERIAL STEEL, FIBERGLASS , OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE r <br /> T <br /> A <br /> N <br /> K <br /> S EXCAVATION SIZE _5 X X JY YDS OF SOIL <br /> A <br /> M <br /> P P DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: TK <br /> ° <br /> B CJ <br /> LABORATORY: 'SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />