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SIT GNT � ADDRESS VJ <br /> OWNER M l (OWNER PHONE <br /> Co o e / - cora. PHONE <br /> FIRE PERMIT a d <br /> REMOVAL CLOS= Mr PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE T7ANK <br /> R RINSED Y ) I HETHOD i Ic/NSA RINSE AMOIINTj <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S iE MANIFEST OR OTHER <br /> V VAPORS PURGED (Y _ ) METHOD ) AMOUNT USED j <br /> P READING AT REMOVAL I L.E.L. : 02 : I, <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL 5_"_L, FIB LASS, OTHER) <br /> 0 / <br /> N TANK CONDITION Sg (POOR, HOLES) <br /> S r <br /> T PIPE MATERIAL (S , FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES 'r L�-'� �11� A.}'� (-j <br /> DEPTH SOIL TSE OBSERVATIONSAMPLE r p <br /> T f <br /> A Cw Si <br /> N / S, CD P <br /> K <br /> Cl/1 <br /> S EXCAVATION S= X X :L YDS OF SOIL <br /> A <br /> M DEPTH SOIL =E JOBSZRVATI0N SAMPLE F <br /> D D <br /> L I / <br /> I P i .¢ iivsl . <br /> G <br /> TRENCH DIIfnFSON X X YDS OF Son <br /> DEPTH TO G.W. :�-I FT./q86 SAMPLING METHOD <br /> H <br /> 2 0 HOURS Sl--Nc 1 DEWATERING: <br /> 0 <br /> OTHER SALMP'_ : <br /> LABORATORY: Gp �n/� L �j SAMPLERS NAME: <br /> CLOSURE IN PLACE I MSXTQRE: VOL=: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />