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PUBLIC p"kLTH SERVICES-ENVIRONMENTA7 HEALTH DIVISION <br /> *SITENAMEADDRESS (4VI CITY �, <br /> OWNER PHONE CONT. PHONENT # �� <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY �7p9SURE <br /> INSPECTOR DATE � pb TANK # 39 /QSIo 'D / 6Q Dp <br /> IRINSED METHOD � RINSE AMOUNT <br /> EIRINSATE DISPOSAL SITE U <br /> S <br /> MANIFEST # OR OTHER <br /> V VAPORS PURGED N) METHOD A_ _ AMOUNT USED /9d� <br /> A �2 <br /> P READING AT REMOVAL L.E.L. : 02 : 30 /J <br /> 0 1 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> O <br /> POOR, HOLES) <br /> N TANK CONDITION GOOD, <br /> S <br /> T PIPE MATERIAL (STEEL, IBERGLASS OTHER) # FEET <br /> PIPE CONDITION GOO , POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A Co Lt sa D t <br /> N <br /> K = 0/ti Aar 3 �9 <br /> t P15CeQlD <br /> S EXCAVATION SIZE ?jS X X YDS OF SOILt �(� <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P &d *OW6 C o <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION 3 ,L1 X 8� X <br /> �'Jd & i YDS OF SOIL ^ a <br /> DEPTH TO G.W. : +V FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />