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PUBLIC E40�:,TH SEMCES-rE VIRONMENTAL�,j ALTH DIVISION <br /> SITE NA1K.ys (/yjr ADDRESS /,j4q i'SGA,&Pn- I rJZ, CITY � 1��-cel <br /> OWNER NALME-�"p`Wt ttV i v WNER PHONE � �d 9� g3 <br /> CONTRACTOR �/�C CONT. PHONE # <br /> FIRE PERMIT <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR I-4.1' "I' DATE 15- q q TANK # 39 <br /> R RINSED (Y/N) METHODSE OIIN'P <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S ! <br /> E MANI:EST JO OR OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNTIIS pQ 72re <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> O <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANX CONDITION (GOOD, POOR, HOLES) <br /> S I= I <br /> u�/ { <br /> ll <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) f <br /> DEPTH ( SOIL TYPE 'OBSERVATION ( SAMPLE 2 f <br /> T <br /> l I ' <br /> N r <br /> K ` I I <br /> S ( EXCAVATION SIZE X 7L YDS OF SOIL <br /> A <br /> M DEPTH ISOlL TYPE I OBSERVATION SAMPLE- <br /> P P I I <br /> L I <br /> I P <br /> r <br /> G <br /> TRENCH DIMENSION % X YDS OF SOIL <br /> DEPTH TO G.A. : FT. SAMPLING METHOD f <br /> H <br /> 2 HOURS SINCE DEWATERING: { <br /> 0 <br /> OTHER SAMPLE: { <br /> jLABORATORY: SAMPLERS NAME: <br /> ,F CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />