Laserfiche WebLink
PUBLIC HbtS,TH SERVICES-EN=ONMENTAL wn ALTH DIVISION <br /> SITE NAME F,R-r VrS/1jL,1 I ADDRESS a6f -41 f�� I CITY STo <br /> OWNER NAME.SHeI 1 I Cyy, IOWNER PHONE ig <br /> CONTRACTOR CONT. PHONE *4 <br /> FIRE PERMIT T� <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CL <br /> INSPECTOR DATE �af�.Q(Q TANK .4 39 <br /> R RINSED (Y ) SHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # OR OTHER <br /> ERV (Y VAPORS PURGED N) (METHOD i �� ( AMOUNT USED <br /> A <br /> P READING AT REMOVAL I L.E.L. : I 02 : <br /> 0 <br /> COMMENTS <br /> C TANK MATERIAL (STEEL, ERGLASS OTHER) <br /> O B <br /> N TANK CONDITIO GOOD POOR, HOLES) Nn 1"L( � <br /> S <br /> T PIPE MATERIALSTE BERGLASS OTHER r FEET <br /> PIPE CONDITION (GOOD .00 HOLES) VttSw- <br /> DEPTH ( SOIL TYPE ( OBSERVATION ISAMPE rl <br /> T <br /> A I SE ' <br /> N it a ` <br /> K I I <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH ( SOIL TYPE OBSERVATION ( SAMPLE 0 <br /> P P I I <br /> L I �, � <br /> I P I Te <br /> N E <br /> T-=TCH 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 SAMPLES <br /> LABORATORY: SAMPLERS NAXE: <br /> CLOSURE IN PLACE HIXTURE: I VOLUME: <br /> rF3 23-0043 (REV 2/23/94) PROVIDE S_TE MAP <br />