Laserfiche WebLink
0 <br /> PUBLIC HEA' n SERVICES-ENVIRONMENTAL H' TH DIVISION <br /> 'r <br /> SITE NAME r ADDRESS 31.3 3 A), ile ?-A� Rd, CITY , c, <br /> OWNER NAME (OWNER PHONE <br /> CONTRACTOR Adv CONT. PHONE <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE .y � Ct TANK ill 39 � <br /> R RINSED (9N) METHOD ' RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E JIMANIFEST rf OR OTHER I <br /> V VAPORS PURGED (Y/N) METHOD C G� AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02:, <br /> 0 <br /> R I COMMENTS <br /> C TANK MATERIAL TE ,FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD, : OR, HOLES) �G �� � . s <br /> S <br /> T PIPE MATERIAL, 42tEEL> FIBERGLASS, OTHER) m FEET <br /> 61 4- aPIPE CONDITION (GOOD, POOR, HOLES) ; <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> 3� <br /> N <br /> 4 gf f, 3 <br /> 3=. <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> E A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE if <br />` P P <br /> L I <br /> N E 3 <br /> G <br /> TRENCH DIMENSION X X 1i YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: f6c <br /> LABORATORY: SAMPLERS NAME: <br /> r <br /> 117 LOSURE IN PLACE MIXTURE: � VOLUME: <br /> 4 EH 23-0043 (REV 2/23/9" ' PROVIDE SITE MAP <br /> r <br />