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PUBLIC HEALM SERVICES-ENVIRONMENTAL HEYLTH DIVISION <br /> SITE NAME ADDRE TITY -T?�lq y <br /> Chevrkv ss3775 -rRACYOW6T C <br /> OWNER NAME OWNER PHONE <br /> CONTRACTOR CONT. PHONE <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE11-1- 1!5 TANK f 39 1 Y� <br /> —FRINSE AMOUNT <br /> R RINSED METHOD-Vtj�,,� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 1_�lc< OR OTHER <br /> IAMOUNT USED 3' <br /> VAPORS PURGED N) METHOD -t�"� <br /> READING AT REMOVAL L.E.L. : 02 : <br /> COMMENTS <br /> C TANK MATERIAL (STE ERGLASS OTHER) <br /> 0 !t�LIE - <br /> N TANK CONDITION (GOOD, HOLE9"ro"-5 46L'l� <br /> S 7*Vk <br /> T PIPE MATERIAL (STEEL OFI±BPERIGIA 0 <br /> (ff� _� THER FEA <br /> T FDEPTH7SOIL TYPE 1OBSERVATION SAMPLE <br /> A I <br /> (0 -2-r 14andylo Wffh2�7 ,v <br /> N v <br /> K <br /> S EXCAVATION SIZE 3OX X YDS OF SOIL <br /> A <br /> M DEPTH I SOIL TYPE OBSERVATION SAMPLE <br /> p P <br /> L I <br /> I P <br /> N E <br /> G TRENCH DIMENSION X 41g_ X IYDS OF SOIL <br /> DEPTH TO G.W. :L�L� FT. SAMPLING METHOD "Cass3aa, <br /> H — I T <br /> 2 HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> F__cLOSURE IN PLA _FVOLUME: <br /> CE _TMIXTURE: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />