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PUBLIC TH SERVICES-ENVIRONMENTAL=nLTH DIVISION <br />SITE NAMED ADDRESS X36 IJ -4,--C7 CITY G Z <br />OWNER NAMEG'=*, JOWNER PHONE <br />CONTRACTOR CONT. PHONE 7Z <br />FIRE PERMIT <br />REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR ���%v DATE �`lL TANK t 39 <br />R RINSED f/ N) METHOD e)L(pGE)le` �'� I RINSE AMOUNT /6'- G <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # 12_ <br />J y/ <br />Co- 7 OR OTHER <br />V <br />A <br />VAPORS PURGED <br />(44;k) <br />� METHOD <br />AMOUNT USED <br />P <br />0 <br />READING AT REMOVAL <br />L.E.L.: <br />02: <br />R <br />I COMMENTS <br />TRENCH DIMENSION X X <br />C <br />TANK MATERIAL <br />E , <br />FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION <br />(GOOD <br />OOR HOLES) <br />S <br />T <br />PIPE ERIAL E FIBERGLASS, OTHER) p FEET <br />PIPE CONDITION <br />(GOOD, <br />00 , HOLES) <br />l <br />S <br />A <br />T <br />A <br />N <br />DEPTH (SOIL TYPE JOBSERVATION SAMPLE <br />I I <br />I I I <br />I � <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />M <br />P <br />L <br />I <br />N <br />G <br />P <br />I <br />P <br />E <br />DEPTH SOIL TYPE OBSERVATION SAMPLE ,# <br />I <br />I I <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />( � <br />CLOSURE <br />i <br />H <br />2 <br />0 <br />( <br />DEPTH TO G.W.: FT. SAMPLING METHOD <br />HOURS SINCE DEWATERING: <br />OTHER SAMPLE: . <br />�i <br />LABORATORY: � SAMPLERS NAME . <br />IN PLACE MIXTURE: ( VOLUME: j <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />