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PUBLIC HI ,TH SERVICES-ENVIRONMENTAL .ALTH DIVISION <br /> SITE NAME ADDRESS 3AB <br /> OWNER NAME OWNER PHONE <br /> CONTRACTOR ' OUzB CONT. PHONE <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> v wti,� <br /> INSPECTOR,,, shw DATE \o-�ljo3 TANK # 39 ' 0\0(3, <br /> R RINSED �0/N) METHOD qpm$ k.- RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) METHOD �f�o AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : b O 02: c <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL ( EEL FIBERGLASS, OTHER) n e� <br /> 0 <br /> N TANK CONDITION t220% POOR, HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, ERG , OTHER) FEET <br /> PIPE CONDITION GOO POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T \gyp' o W a\ �hsC 5r\V-"W►�Y lad <br /> A <br /> N s\ < o\ S G <br /> K Vp \ C -NN"- k' <br /> S EXCAVATION SIZE _�&_ X Q a X \_ YDS OF SOIL -J <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE ¢` <br /> L I <br /> I P <br /> N E <br /> G <br /> L I <br /> TRENCH DIMENSION X k5S 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:` ' SAMPLERS NAME: <br /> IF CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SIT£ MAP <br />