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PUBLIC FzXLTH SERVICES-ENVIRONMENTAT HEALTH DIVISION <br /> SITE NAMEADDRESS CITY Cd <br /> OWNER NAME a OWNER PHONE <br /> CONTRACTOR a?L.P CONT. PHONE # <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE 6 TEMPORARY gSURE <br /> INSPECTOR DATE Y TANK if 39 1656-6 -2- <br /> R <br /> 6SES'0iR RINSED METHOD 6 RINSE AMOUNT �b o <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED (Y N) METHOD / AMOUNT USED : tet <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIALSTEEL, FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION GOOD POOR, HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS OTHER) # FEET :Z-2c)' <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> FR <br /> N <br /> K D 5 <br /> � U&Tdwc.¢o. <br /> S EXCAVATION SIZE 35u'jX jjj X L2A.p YDS OF SOIL 150 J 3 <br /> A uo <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I <br /> I P Hc <br /> N E � <br /> G 757t FA��Z@ <br /> TRENCH DIMENSION 3 ul X (p1 X 30` YDS OF SOIL <br /> Y I <br /> DEPTH TO G.W. : -t-32- FT. SAMPLING METHOD <br /> x <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 />