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lq . <br /> PUBLIC HEA_ H SERVICES-ENVIRONMENTAL 1, '*�_ H DIVISION <br /> SITE NAM SS <br /> CITY <br /> OWNER-NAME- J OWNER PHONE <br /> CONTRACTOR j CONT. PHONE <br /> FIRE PEI T <br /> , <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> ' <br /> INSPECTOR DATE - TANK # 39 I R f /) '2 <br /> R RINSED <br /> METHOD RINSE AMOUNT <br /> I F <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED METHOD 'I AMOUNT USED <br /> I <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> 0 <br /> 1 R COMMENTS <br /> C TANK MATERIAL (STEEL; <br /> TEEL; FIBERGLASS, OTHER) <br /> 0 - " 1'�' c <br /> N TANK CONDITION (GOOD, POOR, HOLES) -1 <br /> S <br /> T IPIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I # FEET <br /> (PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A <br /> L <br /> N <br /> K <br /> S EXCAVATION SIZE X X _ TYDS OF SOIL <br /> A I <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I <br /> I P <br /> N E <br /> G Hl <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 7r HOURS SINCE DEWATERING: <br /> " <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE=MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />