Laserfiche WebLink
PUBLIC SERVICES-ENVIRONMENTAL F�,.LTH DIVISION <br /> SITE <br /> NAME 4.' 0'.� tDRESS 1 0 E. ft�a �=ITYS;4-0 G <br /> OWNER NAME�� C/� I OWNER PHONE <br /> CONTRACTOR rV <br /> CONT. PHONE <br /> FIRE PERMIT , <br /> REMOVAL_ CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE TANK 39 <br /> RRINSED ,(Y'N) ME'T`HOD �Ju RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED OY}'N) METHOD AMOUNT USED <br /> I A <br /> P READING AT REMOVAL L.E.L. : ,,"12. 02: <br /> 0 <br /> R lCOMMENTS <br /> C TANK MATERIAL STEEL FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD, POOR, HOLES) S+e.c� wo vkc S ( � �z lc--q <br /> S <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) FEET reA4ti,�ve�[ <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION ' SAMPLE J4 <br /> T a� Q c <br /> A I <br /> N <br /> K <br /> I <br /> S EXCAVATION SIZE X 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 DIlKENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2HOURS SINCE DEWATERING: <br /> 0 I , <br /> LLIOTHER SAMPLE: -3N <br /> LABORATORY: buo'4 V'A vol-, SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />