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PUBLIC HEAT SERVICES-ENVIRONMENTAL IT-- -H DIVISION <br /> CITY <br /> ADDRESS <br /> SITE NAM' _ <br /> OWNER-NAMF,,- OWNER PHONE <br /> CONT. PHONE <br /> CONTRACTORV � �>-f " <br /> FIRE PEP C <br /> ,.MII <br /> ( 4�� , EzE <br /> 1'�� c- a�Z. L, A <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> i�bE­7f ti <br /> INSPECTOR DATE TANK # 39 <br /> RINSE AMOUNT <br /> R RINSED N) METHOD <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. 02: . ] <br /> 0 <br /> 1 R lCOMMENTS <br /> C TANK MATERIAL/ (STEEL, ' FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, 11 POOR„r <br /> '/ HOLES) <br /> S 1. _� <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> LPIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH <br /> SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> T <br /> FNA <br /> K <br /> S EXCAVATION SI7ZE XX YDS OF SOIL <br /> A <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P A 77 T <br /> L I <br /> I P 6 1 <br /> N <br /> G <br /> TRENCH DIMENSION X IJ X _1YDS Oi"'SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: --7—VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />