Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> TH AL1 <br /> SITE NAMEP,,,, ADDRESSI I �' I CITY ' <br /> OWNER NAME (OWNER PHONE # <br /> CONTRACTOR CONT. PHONE # <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE Q <br /> INSPECTOR DATE I Is9,� TAPIR # 39 <br /> R RINSED ( N) I METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y N) (METHOD :LXOUNT USEDZ� <br /> A Y <br /> P READING AT REMOVAL I L.E.L. : 102 . <br /> O <br /> R COMMENTS <br /> C TANK MATERIAL ( TE FI3E.RGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, POOR, HOLES) (p{ CNVOxdy� <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET I � <br /> PIPE CONDITION (GOOD, POOR, HOLES) Un�nowr� <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A <br /> N ' I I <br /> K I <br /> I <br /> S EXCAVATION SIZE X Z2= X 'IDS OF SOIL 150 d <br /> A <br /> M DEPTH SOIL TYPE (OBSERVATION W�I( <n� (cz--u-" I SAMPLE T � <br /> D <br /> L I , i l 1 <br /> I P � i <br /> 77 <br /> N E o4 I <br /> G <br /> TRENCH 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: SA14P_T,c.RS NAME: <br /> CLOSER Iv PLACE MIXTURE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE ?SAP <br /> Z p°plce5 5-fol ur c&w �l ands -en ca5e 4 6r% c&v-re.-tp, <br /> PUD. ..-•---- <br />