Laserfiche WebLink
PUBLIC HEEAL-H SERVICES-ENVIRONMENTAL HtILTH DIVISION <br /> SITE NAME j �YW I ADDRESS�,�g/f CITY SjtO clri4y� <br /> OWNER NAMESHe ll o; 1 Co, I OWNER PHONE r <br /> CONTRACTOR ( CONT. PHONE <br /> FIRE PERMIT 0 I 67i1� <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR `S f� 9 DATE ; +.),,-`j/a TANK r 39 / l Q �L Oa— <br /> R R--LASED (Y I METHOD R_'NSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS ?URGED C'_s/N) I METHOD cl ry i CJZ_ I AMOUNT USED <br /> A J <br /> P READING AT REMOVAL I L.E.L. : � °JQ 102 : (p,� <br /> 0 <br /> R COMMENTS <br /> C TANK MATERIALSTEP".. FIBERGLASS, OTHER) <br /> 0 <br /> N TANK CONDITION( GOO , POOR, HOLES) <br /> S <br /> T PIPE MATERI16-L TETT FIBERG' OTHER I ' FEET 7 h,Lc taQJ <br /> PIPE CONDITION (GOOD, OOR HOLES) Saivd,H 4� StacQ/ S- / q,- <br /> r. <br /> j DEPTH ISO=- L, TYPE IOBSZRVATT_ON ISAYPLZ s <br /> A I <br /> N is 4t l A, a I S <br /> K 5E . <br /> I I <br /> S EXCAVATION SIZE X X IYDS OF SOIL <br /> A <br /> M DEPTH ISOIL TYPE (OBSERVATION SAMPLE <br /> P P <br /> L I I I I <br /> I P <br /> IN E ( I I I <br /> G I I I <br /> TRENCH DIMENSION X X IYDS OF SOT_L <br /> DEPTH TO G.W. : FT. ( SAMPLING m=-- CD <br /> H <br /> 2 4 HOURS SINCE DEWATE=`TG: <br /> 0 <br /> OTMER SAMPT_,F.: <br /> LABORATORY: SAMPLERS NAME: b's.t,GL; I <br /> CLOS R—r _TN PLACE I ?r XTURE: I VOLUME: <br /> ZH 23-0c043, (REV 2/23/94) PROVIDE nSIT MAP <br /> ,_ <br />