Laserfiche WebLink
PUBLIC HEALTH SZR9ICv-S-"NV-RON1ALITAL HEALTH UIV-L""' <br /> SITE Na.`�Sa `E I ADDRESS �Il Io /V, <br /> Cts") I CITY <br /> J <br /> Owu R NAME / 1 I OwZT�R PHONE # <br /> CONTR ACTOR D - I CON'^. PHONE j <br /> AFIRE PEST r _ <br /> R...iL 4OVAL CLOSIIRE -L ?TYKE <br /> TEMPORARY CLOSURE j <br /> r1TSPECTOR GATE -�a'4 1 TANK 39 a+ <br /> R 2-VSED _' N) METHOD <br /> RIN AMC <br /> I <br /> N R_INSATE DISPOSAL SITE <br /> S <br /> E MANIFEST r OR OTHER <br /> V VAPORS PURGED v/N) I METHOD AMOUNT USED-3"l /bS <br /> A <br /> o READING 2.T R=10VAL I L.E.L. : 02 : <br /> 0 <br /> R COMMEITS <br /> i <br /> C mp1V{ :V.TL-RI_AL STETS, .13ZRGLASS, OTHER) <br /> N TANK CONDITION (GOOD, POOR, HOLES) I fi r"o� papx <br /> `' <br /> S <br /> T PIKE MATERTIL S , =RGLASS, OTHER) Isr FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) vis/E��e <br /> 3 <br /> DEPTH ISOIL TYPE OBSERVATION SAMPLE s <br /> S I <br /> j A S O e- 11K I <br /> � x <br /> I I I I <br /> SESCAV.=GN SIZE Y I YDS OF SOIL <br /> _ <br /> M DEPTH SOIL TYPE OBSERVATION ( SAMPLE F I <br /> P P <br /> L I 1 <br /> T 9 <br /> N EI 1 I I t <br /> G <br /> TRENCH DIMENSION X % ( YDS OF SOIL <br /> I <br /> DEPTH TO G.A. : FT. SAMPLING METHOD <br /> 2 # HOURS SZ4CE DEWA-mv.R_,TYG: j <br /> 0 OTHER SAMPLE: <br /> jLABORATORY: I SAMPLERS NAME: <br /> C'OSIIRE nT PLACE I 2�STURE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />