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PUBLIC HEAT -H SERVICES-ENVIRONMENTAL H"__LTH DIVISION <br /> n <br /> SITE NAMESNtZ� -�4Tc0Aj D SS ,451 waAwloD CITY <br /> OWNER NAME SHEZL OcL OWNER PHONE <br /> CONTRACTOR Gam` c� CONT. PHONE <br /> �r0433- os�8 <br /> FIRE PERMIT Opp_gt{DoZc(-+ <br /> REMOVAL__X CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �(os�n��k�. DATE kZ/'4/4y TANK , 39 �__-��Q C>�-- <br /> R RINSED (2?N) METHOD RINSE AMOUNT <br /> I I I h <br /> N RINSATE DISPOSAL SITE oM�c <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED YPN) METHOD 30lw��1cc. to0o 5...1i <br /> AMOUNT USED <br /> A N ro cw udde <br /> P READING AT REMOVAL L.E.L. : /U 02: / o <br /> 0 <br /> R COMMENTS <br /> C TANK MATERS (STEEL FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD, ,} <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, HOLES) Nl ( <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE r7E <br /> T <br /> A <br /> N <br /> K <br /> S EXCAVATION SIZE ( 0 X 2`50 X ZS YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE , <br /> P P <br /> L I <br /> I P Y <br /> `\ N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : 030 FT. SAMPLING METHOD <br /> H <br /> 2 1 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 3-0043 (REV 2/23/94) PROVIDE SITE MAP <br />