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PUBLIC f` LTH SERVICES -ENVIRONMENTAL EALTH DIVISION <br />SITE NAME)?r➢ -TF 1 1 iADDRESS /n 17 I l l l ' -A <br />— _-�I <br />OWNER NAME 1/11 <br />— •--- <br />OWNER PHONE <br />�— Vl�ev -- IV <br />pan <br />CONTRACTORONT. <br />PHONE <br />FIRE PERMIT <br />REMOVAL CLOSURE IV PLACE <br />TEMPORARY CLOSURE (� <br />INSPECTOR D ATE 15 OI TANK # 39 �S)SrJR <br />R RINSED Y/N) OD Jnrl �C/ RINSE AMOUNT <br />I <br />N <br />S <br />RINSATE DISPOSAL SITE I <br />�W \ L C <br />E <br />V <br />A <br />MANIFEST �,Q� rJS �i(OI OR <br />VAPORS PURGED(Y)N) METHOD <br />OTBER <br />�I� AMOUNT USED eo <br />P <br />O <br />READING AT REMOVAL <br />L.E.L.: <br />( <br />02: O <br />R <br />1 <br />COMMENTS F � • ( � � 51 DV <br />, (� <br />C <br />O <br />TANK MATERIAL (STEEL, FIBERGLASS, <br />OTHER) <br />N <br />S <br />TANK CONDITION (GOOD, POOR OLES) <br />I^ <br />VI be <br />T <br />PIPE MATERIAL EEL FIBERGLASS, <br />OTHER) <br />FEET b��J <br />PIPE CONDITION (GOOD, POOR, HOLES) <br />r <br />DEPTH SOIL TYPE OBSERVATION SAMPLE 24 <br />T41p* <br />Zu.NlQW 1 <br />Z, _ <br />A-E <br />K <br />I <br />i� <br />1$2T <br />S <br />EXCAVATION SIZE IZ X _ X <br />C4 <br />YDS OF SOIL <c5o <br />A <br />M <br />DEPTH (SOIL TYPE OBSERVATION <br />SAMPLE <br />P <br />P <br />L <br />I <br />I <br />P <br />N <br />E <br />G <br />TRENCH DIMENSION X <br />X <br />YDS OF SOIL <br />DEPTH TO G.W.: 13 FT. <br />SAMPLING METHOD b ' <br />H <br />2 <br />0 <br />$ HOURS SINCE DEWATERING: <br />OTHER SAMPL : t TSj --F2_ , Vja+ - -f a &A m OF <br />LABORATORY:6y-oU,Y1A2m <br />S.SAMPLERS NAME: eo-4-ugg <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: i <br />EH 23-0043 (RE`V 2/23/94) PROVIDE SITE MAP <br />al <br />