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SITE <br /> ADDRESS CITY a <br /> OWNER NtEj(/,4. 'o OWNNER PHONE # >r-/d-512- 3-�7 7 <br /> CONTRACTOR JCONT- PHONE P G Z <br /> FIRE PERMIT <br /> REMOVAL CLOSDR.? IN PLACE TIIMFORARY CLOSURE <br /> INSPECTOR DATE TANK # 39 <br /> R RINSED (Y I OD u�, RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL S, <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED `YfY) 11�LTHOD PAY TL-& AMOUNT USED 2 <br /> A <br /> P READING AT REMOVAL L.E.L. : o 02: <br /> 0 <br /> R COMMENTS <br /> C 'PANx MATEI2TA� (.'STS F IBF"Rc_r.a SS, 0TRER.) g <br /> O <br /> N TANK CONDITION (GOOD, POOR, (70LNGl�,6R �,�(;. / " s • <br /> S hLll+Ai. ► t� �j GC G•NT� <br /> T PIPE MA'T*ER AL (ST_L, FIBERGLASS, O r .0 <br /> PIPE CONDITION C G:.OD POOR, HOLES) <br /> DEPTH SOIL -'V-PZ (OBSERVATION SAMPLE <br /> T 1 '. <br /> N <br /> 1 I <br /> S EXCAVATION S-11.7.3 -,E x -zo x YDS OF SOIL 20 GJ <br /> A <br /> M DEPTH SOIL TT?E OBSERVATION SAMPLE - <br /> P P 1 <br /> I P i I <br /> N E j <br /> G I <br /> TP-10TCE DIM=SIoN x x YDS OF SOIL <br /> `7DEPTH TO G.Fi. : FT. SAMPLING METHOD <br /> H <br /> 2 24 HOURS SINCE DErAAm-1 RING: <br /> 0 <br /> oTHrt SA20LE: LG <br /> LABORATORY: � SAMPLERS NAM: <br /> CLOSURE IN PT.ACE VOLUME: <br /> ZHE 23-0043 (R..�V 2/23/94) PROVIDE SITE MAP <br />