Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONY=AL HEALTH DIVISION <br /> SITE NAME �� t1� I ADDRESS /� E. <br /> VVI I CITYC. <br /> OWNER NAME -zm y , OWNER PH/ONE JO-yr <br /> CONTRACTOR D Llr*z CONT. PHONE Ca& <br /> FIRE PERMIT 0 1?- <br /> REMOVAL_ X CLOSURE LN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �'f' �' �` c DATE (p--(P-f5 TANK # 39 1$/"7 <br /> G4 <br /> R RINSED . Y N) v I METHOD RINSE AMOUNT 0 <br /> I _ <br /> N RINSATE DISPOSAL SITE �Gtid Lcyo <br /> S <br /> E MANIFEST P OR OTHER <br /> jvVAPORS PURGED N) (METHOD (AMOUNT USE <br /> ( <br /> READING AT REMOVAL L.E.L. : 02 : <br /> COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) S^ <br /> O L <br /> N TANK CONDITION (GOOD, O(:)R) HOLES) <br /> S <br /> T PIPE MATERIAL S�-,rF,� FIBERGLASS, OTHER) I r FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH ( SOIL TYPE ( OBSERVATION ( SAMPLE <br /> T I i <br /> A I I <br /> N <br /> K I <br /> S EXCAVATION SIZE X 1� X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE (OBSERVATION SAMPLE T <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIME.*TSION X X YDS OF SOIL <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 '.!IXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />