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PUBLIC HEAT El SERVICES-ENVIRONMENTAL H"--LTH DIVISION <br /> SITE NAME G(Xj car ADDRESS <br /> { OWNER NAME OWNER PHONE ;# <br /> i (= <br /> CONTRACTOR s' CONT. PHONE , <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK 39 Sb�o4(p <br /> R RINSED (al N) METHOD dt ���� TiIx--s-E <br /> AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 3 OR OTHER <br /> E V VAPORS FORGED (Y/N) METHOD AMOUNT USED <br /> A C� o/ <br /> L.E.L. : 02: <br /> P READING AT REMOVAL 4 !c <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL STE FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD, POOR, +l%ca;r,lath-c^lk <br /> S <br /> T PIPE MATER2AL T , FIBERGLASS, OTHER) FEET . '} <br /> PIPE CONDITION (GOOD, HOLES) CU;.roSiv,1 <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T l±Q <br /> A <br /> N <br /> K I <br /> I <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A SAMPLE # <br /> M DEPTH SOIL TYPE OBSERVATION <br /> P P <br /> L I <br /> I P <br /> N E <br /> G g YDS OF SOIL <br /> TRENCH DIMENSION X <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 /> 1 <br /> CLOSURE IN PLACE. I MIXTURE= VOLIIME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />