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PUBLIC LTH SERVICES-ENVIRONMENTAZOr .ALTH DIVISION <br /> SITE NAME `� � � �`'Iu�i���`/ ADDRESS `` 1! CCT <br /> \r G 4lc �3 �I} ✓� nrV�J CITY I <br /> OWNER NAME OWNER PHONE , <br /> C:-, S2- `I 5 3 Z <br /> CONTRACTOR CONT. PHONE 44 <br /> FIRE PERMIT <br /> REMOVAL A, CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE <br /> U sn lbw g 12� TANK 39 <br /> R <br /> RINSED (0/N) IRINSE METHOA14OUNT QO <br /> N RINSATE DISPOSAL, SITE <br /> S sbv <br /> E MANIFESTS Fl q6 8 l y s OR OTHER <br /> URRVAPORS PURGED �' N) METHOD AMOUNT USED <br /> READING AT REMOVAL L.E.L. : ` 02: 3 <br /> COMMENTS r <br /> C TANK MATERIAL ST FIBERGLASS, OTHER): <br /> O <br /> 5 TANK CONDITION (GOOD, POO HOLES) <br /> Q <br /> T PIPE MATERIAL (STEEL, IBERG OTHER)l 1102 FEET <br /> PIPE CONDITION (GOOD POO HOLES) <br /> �b�_` � <br /> DEPTH SOIL TYPE OBSERVATION it SAMPLE 24 <br /> .T <br /> A , , F 'i- <br /> N I 7- <br /> ik <br /> .A <br /> S EXCAVATION SIZE _ X [ X OF SOIL <br /> A k�sA <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE � <br /> P P <br /> L I IP <br /> I P <br /> G <br /> TRENCH DIMENSION X X_ YDS OF SOIL <br /> fDTIPTH TO G.W. : q- FT. SAMPLING METHOD <br /> H it b <br /> 2HOURS SINCE DEWATERING: <br /> 00 31 <br /> HER SAMPLE:ABORATORY: SAMPLERS <br /> NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MA <br /> Pk <br /> i <br /> s � � <br />