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PUBLIC HEALTH SERVICES - ENv1xVNMPNrai , nralrrn 1J1V1S1UN <br /> SITE NAME HC,7TX PGc ADDRESS G, , L CITY � <br /> d. `Jcv1 Jc:.t �, <br /> OWNER NAME �t " � ( OWNER PHONE � <br /> \= \ <br /> CONTRACTOR i CONT . PHONE # <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE ��3/C�� TANK # 39 ( ; S UU Z <br /> R RINSED -�a/N ) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR .OTHER <br /> V VAPORS PURGED C /N) METHOD AMOUNT USED � <br /> A <br /> P READING AT REMOVAL L . E . L . : 02 : <br /> 0 <br /> R COMMENTS L <br /> C TANK MATERIALCrSTEEL � FIBERGLASS , OTHER ) <br /> 0 <br /> N TANK CONDITION ( GOOD , POOR ,jLHOLES emirs S ! Jc G � cl �cp <br /> S <br /> T PIPE MATERIAL STEEL , FIBERGLASS , OTHER ) FEET S <br /> SSSSSS <br /> PIPE CONDITION ( GOOD , P00 <br /> DEPTH SOIL TYPE ( OBSERVATION SAMPLE <br /> TA n ri - ijl ' CS l y s <br /> N ©1 I S�anr� .a C ' Ir ;r Inc CCI ^ <br /> K <br /> SSSSSS <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE ` <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X , YDS OF SOIL <br /> Hl L <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 /> EH 23 - 0043 ( REV 2 / 23 / 94 ) PROVIDE SITE MAP <br />