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PUBLIC HF_A ,H SERVICES-ENVIRONMENTAL 1.,. LTH DT_7ISION <br /> SITE NAME S�p M q� � ADDRESS Z �C I/✓YC.Jr�S CITY Go <br /> OWNER NAME /3 T- <br /> OWNER PHONE cg J 57.7- !Z T- <br /> CONTRACTOR nEc �` CONT. PHONE # dal g4-7- ?'-75 -7 <br /> G�'���Jnlrca <br /> FIRE PERMIT 0 ? � 9 <br /> REMOVAL_X CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR c .c' DATE /o/rS�c TANK t 3 9 7 ?j ?j-7 C <br /> R RINSED (Y/N) METHOD _wax- �lNS� RINSE AMOUNT �1S0G' <br /> I <br /> N RINSATE DISPOSAL SITE dl G <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) (METHOD 1 AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : L/• '[ 02 : c, <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIALS2jE ,; FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, , HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION ( SAMPLE <br /> T <br /> A E <br /> N AM 47 alrV2 4650'� <br /> K � <br /> S EXCAVATION SIZE X --3v- X /Z•s^ 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 /> H <br /> 2 iF HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: 5/ u-Cr/ I SAMPLERS NAME: <br /> if—CLOSURE IN PLACE I MIXTURE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />