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PUBLIC HE TH SERVICES-ENVIRONMENTAL \LTH DIVISION <br /> SITE NAME e ADDRESS L41CI CITY E. <br /> OWNER NAME lhaj.j� A/lal WNER PHONE ��LLI'�q3Z' <br /> CONTRACTOR 'SVG' CONT. PHONE # Zoq_ 44-$333 Int{ 1cc <br /> FIRE PERMIT # 00- <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE I .WDb TANK # 39 ff-,�Jp <br /> R RINSED (Yx@ METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S //��/� <br /> E MANIFEST # �1✓� cJrj�{ ?j�j�j OR OTHER �+OAJ_od Q$ hao by EA <br /> V VAPORS PURGED N) METHOD D AMOUNT USED cjQ�VJs <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> 0 <br /> R COMETS <br /> C 1TANK MATERIAL STE FIBERGLASS, OTHER) <br /> 0 <br /> S TANK CONDITION (GOOD, OOR HOLES) <br /> T PIPE MATERIAL (STE , IBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE I OBSERVATION SAMPLE # <br /> T - <br /> A 94T. _ vn <br /> N cGLn nc. �c1J��1t 05 <br /> K <br /> S EXCAVATION SIZE $ X X �_ YDS OF SOIL GJ� <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P p <br /> L 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 /> 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 />