Laserfiche WebLink
i <br /> PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> SITE NAME Lv lir!,o✓ ADDRESS nuc, S, CITY �aDr <br /> Go # <br /> OWNER NAME OWNER PHONE t- ��� <br /> CONTRACTOR 7v T CONT. PHONE 9 5 <br /> FIRE PERMIT # �ry7 j/� ' <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> :oma <br /> I N S P E C T 0 R DATE TANK # 39 U <br /> RINSE AMOUNT ` �✓ <br /> R RINSED /N) METRO T rA <br /> I <br /> N RINSATE DISPOSAL SITE E✓ � <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGEDMETHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : G jv <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (S'I`E—ET FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, OOR, LES) <br /> S <br /> T PIPE MATERIAL &-T� FIBERGLASS, OTHER) # FEET <br /> PIPE CONDITION (GOODCPOOR HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE $ <br /> T ^ 13'C 7;; v Core Nv StrG <br /> N <br /> K <br /> S EXCAVATION SIZE -1, X yG X // YDS OF SOIL <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 YDS OF SOIL^0�" <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME:IF <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />