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PUBLIC HE&H SERVICES -ENVIRONMENTAL WITH DIVISION <br />SITE NAMEJha-a 1401/ <br />e, <br />ADDRESS CITY <br />OWNER NAME R <br />OWNER PHONE <br />CONTRACMC,' t <br />U i <br />CONT. PHONE Of <br />FIRE PERMIT <br />REMOVAL- V CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR DATE _q!S TANK # 39 50 5 <br />R <br />I <br />N <br />S <br />I E <br />V <br />A <br />RINSEDn(Y N) METHOD RINSE AMOUNT C7 <br />I <br />RINSATE DISPOSAL SITE <br />JIMANIFEST OR OTHER <br />VAPORS PURGED CXYN) METHOD I AMOUNT USED(, <br />P <br />0 <br />READING AT REMOVAL <br />L. E. L. <br />02: 3,_7 <br />R <br />COMMENTS <br />C <br />0 <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />N <br />S <br />TANK CONDITION (GOOD, POOR, HOLES) <br />A jhaj <br />r <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />PIPE CONDITION (GOOD, POOR, HOLES) <br />S <br />T <br />A <br />N <br />K <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />71 a 3 -st F,75 <br />pall <br />EXCAVATION �VA T <br />ION SIZE X X <br />YDS OF SOIL <br />'A <br />M <br />P <br />li <br />N <br />G <br />P <br />P <br />nETRENCH <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />DIMENSION x x YDS OF SOIL <br />2 <br />0 <br />DEPTH TO G.W.: FT. SAMPLING METHOD <br /># HOURS SINCE DEWATERING: <br />04 <br />OTHER SAMPLE: T 1 <br />LABOaRR3;. r"&RS NAME: <br />LCLOSURE IN PLACE I Y4IXTURE: <br />I VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />m <br />