Laserfiche WebLink
PUBLIC HEALTH`-;ERVICES-ENVIRONMENTAL HEA, 3 DIVISION <br /> E <br /> SITE NAME ADDRESS CITY <br /> OWNER NAME OWNER PHONE 0 D <br /> CONTRACTOR CONT. PHONE <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE q"$ L�[� TANK # 39 <br /> RRINSED (YIN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E J1 <br /> MANIFEST # OR OTHER <br /> V VAPORS PURGED Y)N) METHOD AMOUNT USED <br /> A �7 <br /> P READING AT REMOVAL L.E.L. : 02: to <br /> 0 <br /> R COMMENTS �' k <br /> C TANK MATERIAL EEL FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, R, HOLES) <br /> S <br /> T PIPE MATERIAL STE IBERGLA OTHER) FEET <br /> PIPE CONDITION (GOOD, OR OLES <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> A Mer go <br /> N <br /> R <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M I DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I AP <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 f HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> —E <br /> -T- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />