Laserfiche WebLink
PUBLIC FLS TH S^Z.-PICES-EyvgtONMENT_U "' LTH DIVISION <br /> SITE NAME I 'ADDRESS 2tV CI'T'Y S� <br /> i <br /> OWNER NAME IOW'N'R PHONE <br /> CONTRACTOR ICONT. PHONE .. � <br /> FIRE PERMIT " G ' I <br /> REMOVAL CLOSURE ri PLACE TEMPORARY CLOSURE <br /> i <br /> INSPECTOR 1 1111011171-� DATE j TANK T 39 r ,r, T-' ,�7 <br /> R RINSED aW) ME OD �� RINSE AMOUNT 2,7 <br /> I <br /> N RINSATE DISPOSAL► SITE <br /> S <br /> E MANIFEST OR OTHER I <br /> i <br /> I ! <br /> V VAPORS PURGED OJN) IMETHOD TA-- <br /> A AMOUNT USZD3?� -/Ll <br /> P READING AT REMOVAL I L.E.L. : 3 02: <br /> ` 0 <br /> R COMMITS <br /> C T_XNK MATrR13L ( E-j), T13 RGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, _OOR, QLcS I �eo J- <br /> S <br /> i T PIPE MATERIAL (STEEL, F 23 ERGLA.SS, OTHER) <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> I <br /> DEPTH ( SOIL TYPE I OBSZRVATION SAMPLE r <br /> T Ii o 4'f-r I -&---5: i <br /> Y I �� <br /> I I i <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M_ DEPTH ISOII, TYPE ( OBSERVATION ( SAMPLE r <br /> L I I I I li <br /> I I P <br /> N E � <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 T HOURS SINCE DEWATERING: <br /> 0 <br /> OTH- SAMPLE: <br /> LABORATORY: J't I SAI=-La"RS NAME: }Z Utiv�^ <br /> CLOSURE IN PLACE ' �: M VOLUME: <br /> 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />