Laserfiche WebLink
PUBLIC HEALTH SERVICES—ENVIRONMENTAL HEALTH DIVISIO <br />AW� 12 <br />EH 23-0043 <br />(REV 2/23/94) <br />puzkozoo <br />• 1 r r �. <br />OWNER PHONE <br />CONTRACTOR <br />'CONT. PHONE <br />REMOVAL • X11.• -CLOSURE <br />• <br />RINSED �� • • r ,.. ,..... <br />•� I alb <br />i <br />I <br />DISPOSAL a <br />I <br />F <br />,.•. r � •r r i� •rs , <br />- <br />iTrF��i�•1+�-� <br />;M <br />� <br />• <br />� <br />• r <br />TANK MATERIAL T FIBERGLASS, OTHER) <br />• <br />CONDITION (GOOD,(�� HOLES) <br />PIPE MATERIAL FIBERGLASS, OTHER) <br />iPIPE CONDITION (GOOD, POOR, HOLES) <br />I&II049OW4. OBSERVATION <br />EXCAVATIONTANK <br />r OF • +f <br />M <br />- <br />OBSERVATION <br />-_�-� <br />■ <br />-_- <br />TRENCH DIMENSION X X YDSOF • <br />• <br />DEPTH • G.W.: FT. SAMPLING METHOD <br />HOURSDEWATERING: <br />CLOSURE IN PLACE <br />EH 23-0043 <br />(REV 2/23/94) <br />puzkozoo <br />