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PUBLIC HEI& SERVICES—ENVIRONMENTAL *LTH DIVISION <br /> SITE NAMADDRESS CIT <br /> 2at- 5a <br /> OWNER NAME OWNER PHONE <br /> CONTRACTOR C Y CONT. PHONE <br /> FIRE PERMIT <br /> REMOVAL_�,G CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DAT ,2 TANK # 39 <br /> R RINSED (Y,4D METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED N) METHOD AMOUNT USED 2 <br /> A <br /> P READING AT REMOVAL L.E.L. : 02 : <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL STE FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOT, (S;) HOLES) <br /> S <br /> T PIPE MATERI TEEL, FIBERGLASS, OTHER) FFEET <br /> PIPE CONDITION (GOOD00 , HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE at <br /> T <br /> A F <br /> N <br /> K 1 N- • � t r E <br /> S EXCAVATION SIZE X XYDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P <br /> L I { _� <br /> I P cr i t r <br /> N E <br /> TRENCH DIIMENSION 1 X � X _L%M) YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />