Laserfiche WebLink
i <br /> PUBLIC Li <br /> mcm SERVICES-ENVIRONMENTAL� EALTH DIVISION <br /> I <br /> SITE NAME ADDRESS <br /> Cl <br /> OWNER NAME OWNER PHONE z4 '. <br /> Fe F <br /> CONTRACTOR CONT. PHONE 24 I i <br /> FIRE PERMIT , <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK #i 39 Q <br />'t R RINSED (Y/N) METHOD 0 A RINSE AMOUNT <br /> I <br /> k N RINSATE DISPOSAL SITE <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) METHOD i� AMOUNT USED ! <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> O ► <br /> 1 <br /> R COMMENTS j <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER)i E <br /> O 1 <br /> N TANK CONDITION (GOOD, POOR, HOLES) <br /> S <br /> J[L PIPE MATERIAL (STEEL, FIBERGLASS, OTHER)�9Ir FEET <br /> j <br /> PIPE CONDITION (GOOD, POOR, HOLES) I I 4 <br /> DEPTH SOIL TYPE ( OBSERVATION 11 " SAMPLE 44 <br /> T <br /> A <br /> S I c"lzig ! <br /> K I I _ ! r I . y � o <br /> � I <br /> ir <br /> S EXCAVATION SIZE X X `IDS OF SOIL i <br /> A <br /> M DEPTH SOIL TYPE OBSZRVATION SAMPLE <br /> P P Ao"C_l <br /> L I <br /> i P <br /> N EI I # <br /> G <br /> TRENCH DZMZNSION X X p YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: j <br /> i3 <br /> LABORATORY. SAMP.�T <br /> ER"S NAME:�F � <br /> p <br /> I CLOSURE IN PLACE ?�2XTURE: j VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE' MAP <br /> I i <br />