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PUBLIC HU'rH SERVICES-ENVIRONMENTAL F-`LTH DIVISION <br /> SITE NAME St-Ie�L S(-AT1nh) ADDRESS 4315 V30j x 6o 2c` CIT <br /> OWNER NAME SH ELL OI` OWNER PHONE # 2 of <br /> CONTRACTOR &1, CONT. PHONE # SICK <br /> FIRE PERMIT #gp_q,i vUZR'* <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR `1 ypS�l` � DATE �2(� 4 TANK # 3 9 - \-4 <br /> R RINSED (VIN) METHOD -7 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # q U OR OTHER <br /> V VAPORS PURGED (YIN) METHOD AMOUNT USED <br /> A r Let- A� ,Q G _ <br /> P READING AT REMOVAL L.E.L. : <br /> 0 <br /> R COMMENTS <br /> T <br /> C TANK MATERIAL ((tEED((TEEDFIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION (GOOD, OOR HOLES) <br /> S <br /> T PIPE MATERIAL (STEM, FIBERGLASS, OTHER) - # FEET <br /> PIPE CONDITION (GOOD, 00 , HOLES) Mouti,T�(d �Or ion <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> A aAAMI <br /> N "-Z- -� <br /> S EXCAVATION SIZE X 5CD X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE # <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 # HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> L[J __F <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />