Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> SITE NAME F1'lbe P r T8 ADDRESS ,7 L ber CITY S <br /> OWNER NAMF,- eveRF}PY�SlOWNER PHONE # <br /> CONTRACTORCONT. PHONE # <br /> FIRE PERMIT r r re Dept +^e Irk <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR lt-X 6P" S DATE'5 ( TANK # 39 J�-6j� � <br /> R INSED (Y N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> EMANIFEST OR OTHER <br /> VVAPORS PURGED .(Y N) METHOD D( � � AMOUNT USED <br /> A <br /> P EADING AT REMOVAL L.E.L. : J 02 : (� <br /> O <br /> RCOMMENTS <br /> C TANK MATERIAL STEEL FIBERGLASS, OTHER) <br /> 0 A <br /> N TANK CONDITION (GOOD, POOR, HOLES) / u 5' _ed /VD bV Ou o1 <br /> S e <br /> T PIPE MATERI STEEL, FIBERGLASS, OTHER) FEET as <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T t <br /> A <br /> N _rAili0,S+ 11r h <br /> K r¢ <br /> S EXCAVATION S ZE * X j X YDS OF SOIL <br /> A 11 <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I i <br /> I P <br /> N E Aq <br /> G <br /> TRENCH DIMENSION X X JiDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: ( ) e- <br /> LABORATORY:¢ © SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />