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7. <br /> PUBLIC HES H SERVICES—ENVIRONMENTAL PNmeLTH DIVISIOr: -12 <br /> L.7 <br /> SITE NAME ADDRESSRic <br /> CITY <br /> OWNER NAME OWNER PHONE _ <br /> CONTRACTOR CONT. PHONE , <br /> FIRE PERMIT , <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE 2 TANK ` 39 �} <br /> RRINSED (Y/ ) METHOD RINSE AMOUNT <br /> I 21 E <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED( (Y N) METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: <br /> O <br /> R COMMENTS/ --#-- <br /> C TANK MATERITEFL FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD( POOR, HOLES) <br /> S <br /> T PIPE MATERIAL TE FIBERGLASS, OTHER) m FEET <br /> PIPE CONDITION (GOOD, POOR), HOLES) <br /> DEPTH SOIL T� ( OBSERVATION ( SAMPLE , <br /> T <br /> N I <br /> K I <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 I <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. TSAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />