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PUBLIC HE: ".H SERVICES-ENVIRONMENTAL i \LTH DIVISION <br /> SITE NAME �WWCADDRESS �� CkCVtGv tt)ojj i CITY S <br /> OWNER NAME ( OWNER PHONE 2 _gS2_G' -D- <br /> CONTRACTOR •S CONTQ21 . PHONE # q_" r �tiK � <br /> sj <br /> FIRE PERMIT .4 (Do_aZ <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK 39 10(n <br /> 129 <br /> R RINSED N) I II3 by METHOD RINSE AMOUNT <br /> I , n <br /> N RINSATE DISPOSAL SITE ��duSt�laQ <br /> S S?X1/lCQ � p . <br /> E MANIFEST .4 qCA I q ()qq l OR OTHER <br /> I <br /> EP <br /> Y VAPORS PURGED N) METHOD l AMOUNT USED 18DlbS <br /> READING AT REMOVAL L.E.L. : 0, 02: 3'1 <br /> COMMENTS100, hCkA &'J ,De <br /> C TANK MATER STEEL FIBERGLASS, OTHER) �� <br /> 0 <br /> N TANK CONDITION (GOOD, POOR, HOLES) �IvipV l <br /> S <br /> T PIPE MATER (STEEL, FIBERGLASS, OTHER) FEET <br /> PIPE CONDITIO OD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE J4 <br /> T swau p <br /> A I t • CO <br /> amN <br /> K <br /> I t� � <br /> S EXCAVATION SIZE X $ X iv YDS OF SOIL '300 <br /> a <br /> M DEPTH ( SOIL TYPE OBSERVATION SAMPLE <br /> L I I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 t 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 />