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>�n <br /> SITE NAME ADDRESS 2j<t1 cti l cxz�cc1�,ea� <br /> OWNER NAME SUSD OWNER PHONE # 4 <br /> CONTRACTOR CONT. PHONE # <br /> FIRE PERMIT # <br /> REMOVAL - CLOSURE IN PLACE TEMPORARY CLOSURE <br /> Q� INSPECTOR c �Ikco DATE (z -3 TANK # 39 GC�a n"5' <br /> \ R RINSED ( ) METHODZV RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S OR OTHER <br /> E MANIFEST # <br /> V VAPORS PURGED &N) METHOD ( AMOUNT USED 4F <br /> A <br /> p READING AT REMOVAL L.E.L. : 02: /2 <br /> 0 <br />+ . R COMMENTS <br /> C TANK MATERIAL ( TE �, FIBERGLASS, OTHER) 'I <br /> N TANK CONDITION (GOOD, o00 , HOLES) <br /> S OTHER) # FEET <br /> T PIPE MATERIAL FIBERGLASS, <br /> PIPE CONDITION (GOOD, POOR, HOLES) Ul Lknow' <br /> DEPTH SOIL TYPE OBSERVATION <br /> 4 SAMPLE # <br /> T <br /> A _ <br /> i N if <br /> f! K <br /> ijYDS OF SOIL <br /> i� S EXCAVATION SIZE X X <br /> It <br /> A SAMPLE # <br /> M DEPTH SOIL TYPE OBSERVATION <br /> t �I P P " <br /> L <br /> I P <br /> N E <br /> GY <br />� TRENCH DII`DIMENSIONX Xi DS OF SOIL <br /> i <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> j EH 23-0043 (REV 2/23/94) PROVIDE SITE M 'A'P <br /> I <br />