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PUBLIC HR s.TH SERVICES-ENVIRONMENTAL i2�ALTH DIVISION <br /> SITE NAME OCAo q� I frg ADDRESS y 3D-1 Gq,? S. U &zblo I CITY'S-�O C k�OYv <br /> OWNER NAME LS OCADki OWNER PHONE t <br /> CONTRACTORAd v Gao coxT. PHONE p 9 �!0 7 <br /> FIRE PERMIT # <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE 1�-\,(-Q7 TANK # 39 <br /> R RINSED a/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGEDL( /N) IMETHOD j C ?240UNT USED <br /> A IP READING AT REMOVAL L.E.L. : 0 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL( FIBERGLASS, OTHER) <br /> 0 L <br /> N TANK CONDITION (GOOD, POOR HOLES) �gyy�Q I 1 (t s I (� >C(51 b►e ha IP ; <br /> S <br /> T PIPE :IAT (STEEL FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A <br /> N <br /> K <br /> i <br /> S EXCAVATION SIZE X X _-fDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION S?�PLE r <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF 50IL <br /> DEPTH TO G.W. : FT. SAMPLING :E'THOD <br /> H i2 r HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> i <br /> LABORATORY: SAMPLERS NAME: j <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />