Laserfiche WebLink
PUBLIC HEALTH SERVICES--ENVIRONMENTAL HEALTH DIVISION <br /> SITE NAME ItG f �ADDRESS70,6 f� E f CITY <br /> OWNER 1 OWNER PHONE ?.C)�� 6 7 <br /> CONTRACTOR` CONT. PHONE <br /> FIRE PERMIT ,#` <br /> Ir <br /> REMOVAL CLOSURE IN PLACE TEMPO CLOS <br /> INSPECTOR DATE 6 -to TANK '39 Sod 6 }LT <br /> R RINSED N) -METHOD~MEMO6� <br /> frre je 1 f AMOUNTSO <br /> I <br /> S RINSATE DISPOSAL SITEJA 7 flr. S <br /> E fl z <br /> MANIFEST {Z7 OR OTHER <br /> V VAPORS PURGED &N) METHOD <br /> A a Z,L, AMOUNT USE a-� <br /> P READING AT REMOVAL L-E.L. : O O2 : q <br /> O 1 <br /> LRCOMMENTS--09-a <br /> C TANK MATERIAL TE FIBERGLASS, OTHER} <br /> 0 <br /> N TANK CONDITION (GOOD, , HOLES). <br /> S <br /> T PIPE MATERIAL E , FIBERGLASS, OTHER) r FEET <br /> PIPE CONDITION (GOOD, , HOLES) - <br /> 7 <br /> DEPTH ( SOIL TYPE OBSERVATION SAMPLE <br /> T 5+ i,�cD �- <br /> A ! <br /> N -SAal sr/4- cn' ., r <br /> S EXCAVATION SIZE Z&Z' X -La! X ZIL YDS OF SOIL 3 <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LJLJLABORATORY: SAMPLERS NAME: Qp <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />