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PUBLIC HE ` ERVICES—ENVIRONMENTAL HEALTH DIVISION <br />Alk <br />.a fts Ir IN <br />OWNER PHONE <br />CONTRACTOR <br />PHONE <br />6337 <br />�I.■ <br />,r <br />- E•TEMPORARY <br />CLOSURE <br />:INSPECTOR <br />DATE <br />RINSED'N) RINSE AMOUNT <br />RINSATE DISPOSAL SIMANIFEST OR OTHER <br />• <br />VAPORS PURGED lsi• <br />READINGREMOVAL• <br />• r <br />•r I <br />Oil! <br />r/ <br />'TANK MATERIAL i <br />FIBERGLASS, OTHER) <br />• <br />CONDITION (.•r..c,HOLES) <br />Qq4i?FIBERGLASS, <br />OTHER) <br />CONDITION (GOOD, <br />HOLES) <br />OBSERVATION <br />EXCAVATIONI'PIPE <br />s OF SOIL <br />OBSERVATION <br />TRENCH DIMENSION X X 1 <br />II <br />Yr OF • <br />• <br />DEPTH •'SAMPLING ♦ r <br />HOURS• E- <br />LABORATORY: PNAME: <br />CLOSURE <br />•• „-, <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />