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PUBLIC H-A-E S�VICES--t"NVIRONME'VTAL *-ZH DMS-TON <br /> SIT= NA3"x -Yg L4AR (ADDRESS *j)75 o5. #74(a 5-7" I CITY sfOG��vvv <br /> Ow-N-c--�z NAME X14Y tO cZ4,40w'rr--e PHONE eao767 i <br /> CONTRACTOR (CONT. PHONE <br /> FIRE PIT <br /> RPL KOV2L_� CLOSURE -`r PLACE TEUMPORARY CLOSIIRE <br /> INSPECTOR , )g DATEl;-q,qg TANK 39I 6 <br /> j R RINSED N) =OD <br /> I - <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST s OR OTH2 <br /> I <br /> I <br /> V VAPORS PURGED (Y/N) I--THC0 (AMOUNT USED <br /> A <br /> P READING AT =,rOVAL I L.E.L. : <br /> I 0 <br /> i <br /> R commENTS I <br /> I <br /> 7Ns <br /> TANK ;L3T�I.3L (ST T:3z2GiASS, OTHER) <br /> ,� LTANK CONDITION (GOOD, POOR, HOLES) F U .T12c�. <br /> T PIPE baTEz I, a (S7, :T , F23ERGLASS, OTHiR) I T r ET <br /> i <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> j DOTH iSOT_L TYPE OBSr.2VATI0N ISAPMULE r <br /> I <br /> AT _ <br /> N S ' I I <br /> K I I i <br /> I I I I <br /> S EXCAVATION SIZE % YDS OF SAIL <br /> � A <br /> M DEPTH SOT1' , TYP: I OBSMWATION SALE T <br /> P P <br /> L I I I I <br /> v E I I I <br /> G I I <br /> TR TCH DIENSICH S X ( YDS OF Som <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> I 2 s HOURS SINCE OZiATERIvG: <br /> 0 <br /> i <br /> OTT.1..rR SAMPLE: <br /> Ii <br /> LABORATORY: Sak?LE?S NAIAIZ: <br /> C,osup-v IN PLACE I HZ t': I VOLDM�: �I <br /> i <br /> 22-0043 (R=7 2/22/94) PROVIDE SITE M-23-0 <br />