Laserfiche WebLink
PUBLIC HFJ&TH SERVICES-ENVIRONMENTAL jTeLTH DIVISION <br /> SITE NAME ADDRESS L CITY <br /> OWNER NAME 0,F OWNER PHONE # - ' <br /> CONTRACTOR I CONT. PHONE <br /> FIRE PERMIT # <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR l(M. IL n DATE _3//y//%/TANK # 39 / 5� <br /> R RINSED (Y/ 7O METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> V VAPORS PURGED (9/N) METHOD _oc- ,V— AMOUNT USED /S� � b <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: S° <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIAL TE FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD 00 HOLES) t"" � * �bs�J`� 6 911 <br /> S <br /> T PIPE MATERIAL BERGLA , OTHER) # FEET <br /> PIPE CONDITION (GOOD, 60 HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A $ c <br /> N <br /> K U, k <br /> S EXCAVATION SIZE X 3/ X YDS OF SOIL TS <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I v S <br /> I P Ntj <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD `2 Qy� <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 />