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PUBLIC H" ;TH SERVICES-ENVIRONMENTAL 'ACTH Di,TISION <br /> SITE NAME 41514 ' <br /> ADDRESS /Uo F- Lid r A✓f. I CITY <br /> s moo/ <br /> OWNER NAME )CfV fir! u7 I OWNER PHONE � 3T _ 6/ <br /> CONTRACTOR � `' i Ears, CONT. PHONE # <br /> _c� <br /> FIRE PERMIT <br /> li <br /> REMOVAL_ V CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �� DATE 71/� T. 4 39 <br /> IRINSED TN) METHOD �. � RINSE APSOUNT iso <br /> N RINSATE DISPOSAL SITE ? 5DE orL� C <br /> S <br /> E MANI-FEST !r/ Tj�� OR OTHER <br /> JRVAPORS PURGED /N) METHOD �2l7 r IAMOIINT USn`D S5� <br /> READING AT REMOVAL L.E.L. : �J %O 02 :COM=s <br /> C TANK MATERIAL (3�' FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD P O , HOLES) <br /> S <br /> T PIPE MATERIAL FIBERGLASS, 0`Ptiy:.R) # FEET <br /> PIPE CONDITION (GOOD, _ , HOLES) <br /> i <br /> DEPTH SOIL TYPE OBSERVATION ( SAMPLE <br /> T -to( .5�) * G 4c-i(r v ®, o s f�a�a. -rG' <br /> A <br /> N / IJ. % LnM. 1 ,4v 50.L DrSGv�v.�brr TL <br /> R <br /> I <br /> S I EXCAVATION SIZE -5"1'- X-_' X YDS OF SOIL <br /> a <br /> MDEPTH SOIL TYPE iOBSERVATION SAMPLE .4 <br /> P P <br /> L I <br /> I P <br /> N E <br /> G <br /> D <br /> T_l?_=CH DIMENSION X X YDS OF SOIL <br /> i <br /> DEPTH TO G.'A. : FT. I SAMPLING METHOD <br /> i <br /> H � <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTMER SAMPLE: <br /> LABORATORY: I SAMPLERS :TAME: <br /> CLOSURE IN PLACE I KIXTURE:iF i VOL=: <br /> EH 23-0043 (R.EV 2/23/94) PROVIDE SITE MAP <br />