Laserfiche WebLink
PUBLIC HEkVTH SERVICES-ENVIRONMENTAL 4WtLTH DIVISION <br /> SITE NAME ADDRESS �- CITY <br /> OWNER NAME (OWNER PHONE J <br /> CONTRACTOR CONT. PHONE , <br /> FIRE PERMIT <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE Z STANK 39 2 , <br /> R RINSED } METHODRINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V [VAPORS PURGED ( ) METHOD c-� AMOUNT IISED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: <br /> O <br /> R COMMENTS <br /> C TANK MATER (STE , FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, 00 , HOLES) <br /> S <br /> T PIPE MATERS_ FIBERGLASS, OTHER) I70 FEET <br /> PIPE CONDITION OD, POO HOLES) <br /> DEPTH SOIL TYPE ( OBSERVATION SAMPLE J <br /> T d 21 <br /> A <br /> N <br /> K I <br /> S EXCAVATION SIZE X X YDS OF SOIL 14R <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I I <br /> I P i <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H i <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: f <br /> I <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/2,1,194) PROVIDE SITE MAP <br /> �. <br />