Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> AWL <br /> SITE NAME ADDRESS « [� LCITY p? . <br /> OWNER NAME '^ OWNER PHONE # fVj <br /> CONTRACTOR CONT. PHONE # <br /> FIRE PERMIT # <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE 7 TANK # 39 <br /> R RINSED ( ' ) METHOD RINSE AMOUNT <br /> aer <br /> I <br /> N RINSATE DISPOSAL SITE n of L <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (27N) METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : /D 02 : J, 7 a <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL E FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, CP�a�; 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 <br /> N <br /> K <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 f X ^ 60 ' X ^ Z� YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> Lj LABORATORY: 5;r4� SAMPLERS NAME:11— <br /> GNU = <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />