Laserfiche WebLink
PUBLIC HEA- SERVICES-ENVIRONMENTAL H' -STH DIVISION <br /> SITE NAME ADDRESS CITY <br /> OWNER NAME OWNER PHONE # <br /> CONTRACTOR \J L CONT. PHONE <br /> FIRE PERMIT #r?SNov33 <br /> REMOVAL x CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR 9pSYltOECc DATE i2�jQG,j,q TANK # 39 <br /> R RINSED 6�rN) METHOD �_ /. �Ly� RINSE AMOUNT ] <br /> I E"" xz <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # �13391J-9� OR OTHER <br /> V VAPORS PURGED (YWN) METHOD Sp' wry AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : y 02 : d <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, OOD�, HOLES) <br /> S lJY <br /> T PIPE MATERIAL TE , FIBERGLASS, OTHER) # FEET U' <br /> PIPE CONDITION (GOOD, 00 , HOLES wJfvS ow <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> i - <br /> A 15Gd.i — Z N <br /> N Yz' <br /> K <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A J <br /> M DEPTH SOIL TYPE OBSERVA7SON SAMPLE # <br /> P P C( T 1 <br /> L I <br /> I P <br /> N E t <br /> V� oa -2 <br /> G HTRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: a n', q {iCc I SAMPLERS NAME:F'trGd StCul <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />