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PUBLIC HB4 PH SERVICES-E.` =ONMENTAL .,,,lLTH DIVISION <br /> SITE NAME IADDRESS LN�9 )C6 7-f CITY e-z�,4 <br /> OWNER NAME A I OWNF4 PHONE # 3 3 <br /> CONTRACTOR d/L CONT. PHONE ���f _ 6,75 <br /> FIRE PERMIT # <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR 17— DATE7X0�y TANK # 39 Sv5��p7 <br /> R RINSED ft71N) METHOD RINSE AMOUNT /SDS <br /> I <br /> N RINSATE DISPOSAL SITE �GIy/ 6i <br /> S <br /> E MANIFEST # �lY/// Zf? 7 OR OTHER <br /> V VAPORS PURGED ) METHOD �QGJ / I AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : S % 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL T4' , FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD, (POO HOLES) i <br /> S <br /> T PIPE MATERIAL (STEEL,ClUBER61,11S , OTHER) # FST <br /> i <br /> PIPE CONDITION (GOOD --, HOLES) I <br /> DEPTH ( SOIL TYPE ( OBSERVATION ( SAMPLE # <br /> T 40- <br /> N <br /> K <br /> S EXCAVATION SIZE^3n X x53 X /1 YDS OF SOT_=. Z=d <br /> A <br /> M DEPTH ( SOIL TYPE OBSERVATION SAMPLE # <br /> L I ` Com+ I <br /> I P <br /> N <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING MESHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: GFU�I�I �Tr�fi SAMPLERS NAME: <br /> CLOSURE IN PLACE .SXTURE: I VOLZTbME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE XtA.P <br />