Laserfiche WebLink
PUBLIC H A:� SERVICES—ENVIRONMENTAL HL eTH DIVISION <br /> SITE NAMEP � DRESS . J CITY S7OC, <br /> OWNER NAME rOWNER PHONE # <br /> CONTRACTOR C Y�&tpi CONT. PHONE <br /> FIRE PERMIT # �(� 3 <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �ld ' �. DATE "�.. � TANK # 39 /S] 3 6_Z <br /> 'T <br /> RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> LVVAPORS PURGED (Y/N) (METHOD (AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: <br /> 0 <br /> R COM.M=S <br /> C TANX MAT== TEFL FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, OOR HOLES) Y � 2 kle) 'W � <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I # FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH ( SOIL TYPE ( OBSERVATION ( SAMPLE $ <br /> T I " <br /> N Srl <br /> K 1 <br /> � I <br /> S ( EXCAVATION SIZE X X YDS OF SOIL <br /> A '_' <br /> M DEPTH ( SOIL TYPE OBSERVATION SAMPLE # <br /> p p <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> LaiRS SINCE DEWATERING: <br /> SAMPLE: <br /> ATORY: Gyp ,C SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />