Laserfiche WebLink
PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />SITE NAME CQ2 <br />ADDRESS 3S3S C - Cl <br />CITY �� <br />OWNER NAM <br />OWNER PHONE # -/o <br />75t{• Z 0 SQ <br />CONTRACTOR �G E <br />CONT. PHONE # 2,04 <br />q5(p 0 Z (O y <br />FIRE PERMIT <br />REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR DATE l�-�F / 7 TANK # 39 <br />R <br />I <br />RINSED UN) METHOD �jL <br />RINSE AMOUNT <br />QTS <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # OR OTHER <br />A <br />VAPORS PURGED (Y N) METHOD <br />AMOUNT USED <br />P <br />O <br />JRV <br />READING AT REMOVAL L.E.L.: �,2 % <br />02: 9,C/ <br />COMMENTS <br />C <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITIONGOOD POOR, HOLES) <br />S <br />T <br />PIPE MATERIAL STEEL FIBERGLASS, OTHER) <br /># <br />FEET Zpp <br />PIPE CONDITION (GOOD1(POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />TT/ <br />A <br />Ea. C <br />N <br />K <br />S <br />EXCAVATION SIZE ZS X 50 X I3 <br />YDS <br />OF SOIL z: 3003 <br />A <br />M <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />P <br />P <br />I <br />lip -i <br />L <br />I <br />P <br />N <br />E <br />G <br />Ll <br />TRENCH DIMENSION As' X Z.D, X <br />ISO YDS OF SOIL ? <br />DEPTH TO G.W.: FT. <br />SAMPLING METHOD <br />H <br />2 <br /># HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />