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ebLluTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> SITE NAMFS3. d ADDRESS <br /> �l SI rc, CITY S ,,. <br /> OWNER NAME-d ( !OWNER PHONE 71 P <br /> CONTRACTOR;jj �cA c 100. <br /> tCONT. PHONE <br /> FIRE PERMIT i T b <br /> REMOVAL CLOSURE IY PLACE TEMPORARY CLOSURE <br /> INSPECTOR � DATE . ./6, �s- TANK 3 9 i z <br /> R RINSED METHOD I cy <br /> I RINSE AMOUN72073 <br /> j N RINSATE DISPOSAL, S171-7 <br /> 15 <br /> MANIFEST OR OTHER <br /> I ' <br /> eJ VAPORS PURGED /'.d) I METHOD ! <br /> A f AMOU T USED <br /> o READING AT REMOVAL L.E.L. : 02 : <br /> 7, S— <br /> R <br /> R COTS <br /> P <br /> C TANK MATERIAL STE FIBERGLASS, OTHER) <br /> Or`eD <br /> 1 N TANK CONDITION (GOOD, DO fOLE <br /> T PIPEHATERr AL .T E T 1 I <br /> f FIBERGLASS, OTHxR) i ,T FEET l <br /> fPI-2E CONDITION (GOOD. ?Q4, HOLES) l <br /> DEPTH ISCIL TYPEOBSERVATION SAMPLE. ,T=' <br /> I <br /> no ckr�c. cr z Z i <br /> jf O. I Sam I coo r►c... <br /> 1 � nro <br /> S i EXCAVATION SIZE W ` x <br /> A '/ YDS of SOIL ��ry r`� 7 o6 <br /> DEPTH I SOIL TYPE' JOBSER <br /> VATION <br /> ? P I SAMPLE <br /> 17 f I S npz I <br /> G � � <br /> I I <br /> TRENCH DIMENSION X X f YDS OF SOIL <br /> DEPTH TO G.W. : � FT. SAMPLING METHOD <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> ,f 1 ORATORY: P� SAMPLERS NAGE: lowj <br /> CLOSURE IN PLACEj MUE. <br /> VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />