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PUBLIC HEAL S,7RVICES-ENVIRONmNTAL HEE DIVISION <br /> SITE NAME -YA M A R— I ADDRESS/S()�S � � I CITY <br /> OWNER NAME_fIQ M LjEJ40�4OWNER PHONE 1/la o2 — E70 7 <br /> CONTRACTOR ,S-hb ecj, (CONT. PHONE <br /> FIRE PERMIT <br /> REMOVAL_ CLOSURE PLACE TEMPORARY CLOSURE <br /> INSPECDATE TANK # 39 <br /> R RINSED (Y/N) - 'aOD RINSE AMOIINT O <br /> I � <br /> N RINSATE DISPOSAL SIS' <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) (METHOD AMOUNT USED <br /> A <br /> P READING AT REMOVAL I L.E.L. : 02: 3 <br /> 0 <br /> R COMMENTS <br /> C TANK MATE22AERGLASS, OTHER) <br /> a D K . <br /> N TANK CONDITION (GOOD ,POOR 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 /> N <br /> K a <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE IOBSERVATION ISAMPLE <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> TRENCH DIMENSICH X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DFAATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE I KXTIIRE: I VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />