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PUBLIC HEA.T-''B SERVICES-ENVIRONMENTAL Iz- `LTH DIVISION <br /> SITE NAME gH�ic. S(�q<<o� ADDRESS 4315 wa�Y Lao Ra CIT <br /> OWNER NAME SH c�L O�L OWNER PHONE # Z VQ q 3(- &o:444 <br /> CONTRACTOR CONT. PHONE ', S1� G <br /> FIRE PERMIT ` 4_qy UUZR� <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �pS`1 DATE �2��. Q y TANK # 3 9 - `�(o <br /> R RINSED (�/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED a'N) METHOD f� ,Iv�r G AMOUNT USED <br /> A - <br /> P READING AT REMOVAL L.E.L. : <br /> 0 <br /> R COMMENTS T <br /> C TANK MATERIAL (OtEslFIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD, OOR HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) , FEET <br /> PIPE CONDITION (GOOD, 00 HOLES) Ma�.�,(� ,�� ta✓1 <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE ,yE <br /> T <br /> A <br /> N <br /> K <br /> S EXCAVATION SIZE � q X 5(DX ? YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE „f <br /> P P <br /> L I <br /> 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 ,if HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br /> f # <br />