Laserfiche WebLink
PUBLIC HEAT '7 SERVICES-ENVIRONMENTAL H' '',TH DIVISION <br /> SITE NAME ADDRESS tt 3(S _ / (� CITYU;, <br /> OWNER NAME OWNER PHONE # ZU y Q J31 _34ayl <br /> CONTRACTOR o\ ch 1, CONT. PHONE �73� <br /> FIRE PERMIT <br /> REMOVAL JC CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR �� �( DATE l� S TANK # 39 - <br /> R RINSED ON) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # 2U 414 a OR OTHER <br /> V VAPORS PURGED (Y/N) METHOD 3O 'bDr.�(cc. !O �- AMOUNT USED <br /> A <br /> f P READING AT REMOVAL L.E.L. : lj 3 02 : <br />/i 0 <br /> R COMMENTS <br /> C TANK MATERIALSTE ,I, BERGLASS, OTHER) <br /> O <br /> N TANK CONDITION GOO POOR, HOLES) <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> PIPE CONDITION (GOOD, POOR HOLES) �C)- �' 'ro4b 'f ¢ <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> A <br /> N <br /> K <br /> S EXCAVATION SIZE X 30 X _ YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> P P <br /> L I ' <br /> I P l T c <br /> N E <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : �>SO FT. SAMPLING METHOD <br /> H <br /> 2 # HOURS SINCE DEWATERING: <br /> 0 <br /> LIJOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />