Laserfiche WebLink
PUBLIC HF?iN-1 SERVICES-ENVIRONMENTAL lfj""�TH DIVISION <br /> SITE NAME e L�G� I ADDRESS/9901` CITYp G <br /> OWNER NAME GPJt jGj` r p oC� OWNER PHONE 24 S�j�,qtt �-!3� 7A 3 -74'�Co <br /> CONTRACTOR CONT. PHONE } I <br /> FIRE PERMIT I I <br /> O CLOSURE ZY PLACE TEMPORARY CLOSURE <br /> INSPECTOR Le �,tf u' _ DATE 7 7 TANK , 39 <br /> -T <br /> R RINSED (Y/Nm=OD RINSE AMOUNT <br /> I <br /> N R2NSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) METHODN AMOUNT USED <br /> A <br /> P READ IPTG AT REMOVAL L.E.L. : N14 �,. r y4 02: <br /> O <br /> R COMMENTS ("i �Q� v<Di a.Gvr h lliry S� 4x2G� h��' a <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, POOR, HOLES) <br /> S <br /> T PIPE MAT=AL (STEEL, FIBERGLASS, OTHER) T.4 FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TY?, !OBSERVATION SAMPLE <br /> T <br /> K t r �c d K <br /> I ) <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE I OBSERVATIONfd _ _ SAMPLE <br /> P P <br /> L I - 1 <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSICB (�► X X —aL YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 rx HOURS SINCE Dr�TE.RING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY:!r! AMPLERS NAME• <br /> CLOSURE IN PLACE HIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />