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PUBLIC HEA -T-7 SERVICES -ENVIRONMENTAL H- TJTH DIVISION <br />SITE NAME <br />ADDRESS <br />CITY <br />OWNER NAME <br />(OWNER PHONE # <br />CONTRACTOR <br />CONT. PHONE # <br />FIRE PERMIT # <br />REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR DATE TANK # 39 <br />R <br />I <br />RINSED (Y/N) <br />METHOD <br />RINSE AMOUNT <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />V <br />A <br />P <br />0 <br />R <br />C <br />0 <br />MANIFEST # OR OTHER <br />VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />READING AT REMOVAL L.E.L.: 02: <br />COMMENTS <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />N <br />S <br />TANK CONDITION (GOOD, POOR, HOLES) <br />T <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />PIPE CONDITION (GOOD, POOR, HOLES) <br />S <br />A <br />T <br />A <br />N <br />K <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />M <br />P <br />L <br />I <br />P <br />I <br />P <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />G <br />E <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />LLOTHER <br />H <br />2 <br />0 <br />DEPTH TO G.W.: FT. <br />SAMPLING METHOD <br /># HOURS SINCE DEWATERING: <br />SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />