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PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> E:FI'R,E <br /> ME ,tl 6b ADDRESS !i <br /> AME OWNER PHONE ` <br /> CONT. PHONERMIT <br /> REMOVAL�1 _ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATETANK # 39 <br /> R RSNSED 6/1;) METHODr y� RINSE AMOUNT Q <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E IMANIFEST # C 7�n-7"Z( C OR OTHER <br /> V VAPORS PURGED N) METHOD r1.� AMOUNT USED <br /> A <br /> P READING AT REMOVAL. 7 L.E.L. : lfb 02: �o <br /> O <br /> R COMMENTS �FlC <br /> C TANK MATER2AI'` ' FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD, 4 9� HOLES) <br /> S <br /> T PIPE METERrnr, (STM,(JCER_G� OTHER) 1.4 FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> K � I <br /> S 1EXCAVATION SIZEjv <br /> x (11�1i.1 X YDS OF SOIL <br /> A SAMPLE <br /> M DEPTH SOIL TYPE OBSERVATION <br /> P Pn- 1 44 <br /> L I <br /> I P <br /> N E <br /> G <br /> TRWCH 033ONSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS S33CE DEATATERING: <br /> 0 <br /> O'T'HER <br /> SAMPLE: <br /> LABORATORY: SAMPLERS gam: <br /> CLOSURE IN PLACE MIXTURE: VOLS: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />