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PUBLIC HEATTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />SITE NAME i r TRAIL <br />ADDRESS o�_36S ,S • 4; r r r <br />CITY fD G k1o"t-1 <br />OWNER N ' iIie_ <br />I OWNER PHONE <br />CONTRACTOR P ;r - <br />CONT. PHONE 0 <br />FIRE PERMIT 0 <br />REMOVAL' X CLOSURE IN PLACETEMPORARY CLOSURE <br />INSPECTOR 2{7 i7 f DATEJ-AQ-Jpp v TANK t 39 <br />R <br />RINSED Y N) METHO RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST OR OTHER <br />V <br />VAPORS PURGED (Y/N) (METHOD AMOUNT USED <br />A <br />P <br />READING AT REMOVAL L.E.L.: °7� <br />02: <br />0 <br />R <br />COMMENTS <br />C <br />TANK MATERIAL(JSTEEL FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION oo POOR, HOLES) <br />S <br />T <br />PIPE MATERIAL STE FIBERGLASS, OTHER) <br />FEET (� <br />PIPE CONDITION (GOOD, OOR HOLES) y u/JLGt 1/e� <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />T <br />A <br />� <br />N <br />a <br />K <br />S <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />A <br />M <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />P <br />P <br />L <br />I <br />I <br />P <br />N <br />E <br />S <br />G <br />TRENCH DI=SION X X <br />YDS OF SOIL <br />DEPTH TO G.W.: 3c) FT. <br />SAMPLING METHOD <br />H <br />2 <br />HOURS SINCE DEWATERING: A,1� <br />0 <br />OTHER SAMPLE: ,e rk.. % <br />LABORATORY: S&�,tV_aor <br />T <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />.e <br />