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PUBLIC HEAT,TH SERVICES -ENVIRONMENTAL HFALTH DIVISION <br />SITE NAMEAirPprt- nm;D$ <br />ADDRESS,_�36)74 <br />CITY S/dG��Ovc. <br />OWNER NAME i (ie <br />h^5/ <br />OWNER PHONE <br />CONTRACTOR JAy 1�1`r <br />CONT. PHONE <br />FIRE PERMIT y6- /7F� <br />REMOVAL x CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR�i fi li i3f"94S DATE d �l(v TANK t 39 a '/70 o a <br />_J <br />R <br />I <br />N <br />S <br />E <br />V <br />A <br />RINSED Y N) METHOD T/tit RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />MANIFEST # OR OTHER <br />VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />P <br />0 <br />READING AT REMOVAL <br />L.E.L.: 0 <br />02: J <br />R <br />COMMENTS <br />C <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION 00 , POOR, HOLES) <br />Spry e / LIQ <br />S <br />T <br />PIPE MATERI STEEL FIBERGLASS, OTHER) <br />FEET Sr% <br />�t <br />PIPE CONDITION (GOOD, HOLES) /icua. V__ o <br />00 <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />A <br />N <br />KY <br />trill <br />11 —S EXCAVATION SIZE X X <br />YDS OF SOIL <br />A <br />M <br />P <br />P <br />DEPTH SOIL TYPE OBSERVATION SAMPLE $ <br />L <br />I <br />N <br />I <br />P <br />E <br />% <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />DEPTH TO G. W. C�) FT. <br />SAMPLING METHOD <br />H <br />2 <br />0 <br /># HOURS SINCE DEWATERING: rf� <br />OTHER SAMPLE: <br />LABORATORY: CCP lvG <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />