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• _ -BvsZ.xc srRarxcss—�avxaonx�nr-r c, ax..i szo.. <br /> SITE NAME JADDRESS l l'ik 6 � CITY <br /> OWNER NAMED OWNER PHONE # ` <br /> CONTRACTOR I�C39nU S CONT. PHONE # I <br /> FIRE PERMIT <br /> L <br /> REMOVAL_X IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �5 tok� DATE (2/p3/()G TANK f 39 IOQ'�- O� <br /> I RINSED ON) METHOD 1-.0 ` RINSE AMOUNT�� 07J <br /> N RINSATE DISPOSAL SITE <br /> I S ' <br /> E MANIFEST # OR OTHER 'if <br /> GA VA VAPORS PURGED ( ,2J) METHOD �� AMOUNT USED <br /> P READING AT REMOVAL L.E.L. : 3 02: <br /> O <br /> R COMMENTS <br /> C TANK MATERIAL qgjEL FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD, POO , HOLES) %)ZbkOA ;^c-' c�aa � <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) Wi11Wou�r RP.��1Uu �O ^ � <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE $ <br /> T tit or <br /> NRw <br /> K k <br /> � If <br /> I <br /> S EXCAVATION SIZE X X I'DS OF SOIL ��Uj yol <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION IC SAMPLE # <br /> i PP d <br /> L I I _ <br /> I P <br /> N E <br />�. G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> i DEPTH TO G.W. : Coo-t- FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> 0 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP ' <br /> i <br />