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SITE NAME -c__�- <br />ADDRESS 3Cy� <br />�je,,� �_ <br />CITY :�tccktc'� <br />OWNER NAME ;1 - <br />OWNER PHONE <br />CONTRACTORK <br />CONT. PHONE <br />FIRE PERMIT <br />REMOVAL CLOSURE IN PLACE <br />TEMPORARY CLOS <br />INSPECTOR �idS`l O�ict DATE (C)/,q/q6 <br />TANK if 39' <br />R RINSED 1IN) METHOD ' S vlS �_ RINSE AMOUNT 4j a <br />I <br />N <br />RINSATE DISPOSAL SITE��v� <br />S <br />E <br />MANIFEST # �� �7 OR <br />OTHER <br />V <br />VAPORS PURGED 7) METHOD <br />�AMOUNT USED '3(30)bo <br />A <br />P <br />0 <br />READING AT REMOVAL L.E.L.: �� <br />02: <br />R <br />COMMENTS <br />C <br />TANK MATERIALSTE , FIBERGLASS, OTHER) <br />0 <br />N <br />TANK CONDITION (GOOD,(POok, HOLES) <br />` <br />S <br />T <br />PIPE MATERIALL�STEii, FIBERGLASS, OTHER) <br /># FEET <br />PIPE CONDITION (GOOD, POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />T <br />A <br />N <br />K <br />S <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />A <br />M <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />L <br />I <br />- C c 07 <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.: FT. <br />SAMPLING METHOD <br />H <br />2 <br /># HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />