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PUBLIC HE2 G SERVICES—ENVIRONMENTAL H" ",1,H DIVISION <br /> SITE NAME�rS S f� I ADDRESS3/3 l &G CITY \S L <br /> OWNER NAME Te�WNER PHONE <br /> CONTRACTOR / f I CONT. PHONE <br /> FIRE PERMIT # <br /> REMOVAL CLOSURE =T PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK 0 39 /5 14 — .6 2, <br /> R RINSED (Y/ ) METHOD RINSE AMOUNT 36'Q <br /> I <br /> N RINSATE DISPOSAL SIT.' <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED (Y N) METHOD j �_ AMOUNT USED -50 <br /> A <br /> P READING AT REMOVAL i L.E.L. : U 02: y <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL,,41ERGLAS OTHER) <br /> 0 <br /> N TANK CONDITION <JGOO POOR, HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL„ rIBERGLAS , OTHER) f FEET <br /> PIPE CONDITION GOOD =COR, HOLES) <br /> DEPTH I SOIL TY-2E E I OBSERVATION SAMPLE <br /> T <br /> A I I <br /> N <br /> K <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A 11 — <br /> M DEPTH SOIL TYPE (OBSERVATION SAMPLE if <br /> P P <br /> L IV1,11 I s I <br /> I P i <br /> N E 94 <br /> G <br /> TRENCH DIMENSION X XYDS OF SOIL <br /> DEPTH TO G.W. : FT. ( SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MrATURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />