Laserfiche WebLink
VIRQNMMlTTAL HEALTH <br /> SITE �` DIVISION <br /> c ADDRESS <br /> flFv'N NAME ) Cu &5( <br /> j CITY S . <br /> � �CLQ PH©NE ,� <br /> C'ONTRACTQR,,Iwlc-s �c, � 7� ��a$ <br /> tq CONT. PHONE / <br /> FIR£ PERMIT Iris �b <br /> REMQVAI, CLOSURE rN PLACE f <br /> TEMPORARY CLOSURE <br /> INSPECTOR r� �I /e - DATE <br /> _R RINSED < 39 <br /> m) ME'T'HOD -7 — <br /> RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE O 7 <br /> S <br /> E <br /> MANIFEST <br /> f OR OTHER <br /> I V VAPORS PURGED /N) METEO l <br /> i <br /> � AMC UNT USED <br /> P � Q1� � <br /> READING AT REMOVAL L.E.L. : <br /> O O2 : <br /> R COMM—ENTS <br /> C T_AN*K 2K T <br /> O _ERIAL TE' FIBERGLASS, OTHER) U <br /> 0-0 <br /> N f T191K CONDITION (GOOD, 00 / f <br /> S io, HOLES) <br /> �7T�E �7T�^ <br /> ' I. i, TE�''' FIBERGLASS, OTHER) 0 F <br /> 1EET7- <br /> i' PIPE CONDITION (GOflD, <br /> MOLES) !, <br /> J � H SOIL TYPE I <br /> T DEPTE OBSERRVATION <br /> J A Q , 1 1 S 6 ISAMPL£ I <br /> 1 N <br /> 4) L) <br /> i <br /> f S <br /> j EXCAVATION SIZi �xA � <br /> I <br /> ! / X { � YDS OF SOIL <br /> J M DEPTH ( SOIL TYPE OBSERVATION <br /> j ? P i <br /> I ZSAMPLE 1 <br /> N E I .s + <br /> G <br /> TRENCH DIMENSION X � <br /> x , YDS OF salL <br /> DEPTH TO G.W. : .FT <br /> I3 SAMPLING METHOD <br /> 2 s <br /> 0 HOURS SINCE DEWATERING: <br /> lO'7-HER SAMPLE: <br /> LABORATCRY: +f <br /> I PGi V, j SAMPLERS Nr�;SE <br /> CLOSURE IN PLACE <br /> VOLUME: + <br /> EH 23-4043 (REV 2/23/94} PROVIDE SITE MAP f <br />