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PUBLIC HZ ;;TH SZRVI=-MT=QNZMqTAL HEALTH 02VI520N <br /> SITE Nr Q�� G -� ADDRESS CITY <br /> s <br /> OWZT-r..4 NAME. vb� Drc �bL 4WZIER PHONE <br /> CONTRACTOR � CONT. PHONr. <br /> 'CrC V i <br /> FIRE P-1ST } <br /> R��-XOV-A--u S�uRE _*T Pr3cE TELlPORAR`T C.r.4SI3Rx: <br /> PIS P E CTO R K). p DATE °� �st� TPl'7K .r 3 9 <br /> R RyTVSED (YIN) METHOD R-YsE AMC= <br /> I <br /> N RINSA'T-'E DISPOSALS <br /> S <br /> i <br /> E i '�i=-EST T OR OTS' � <br /> jV VAPORS PGRGZD (Y/N) MoD AMoGNT USED <br /> P RE ZPIG AT L.E.L. : 02: I <br /> i <br /> O <br /> R comm *rs <br /> c TaL' 0'-' <br /> N T LN--K CONDITION (CLCD, PCGR, HOLES) <br /> j S ' <br /> T a IPE ?�Rw`E'�I_A: (ST-T='T•, :'23ERGLaSS <br /> o r:?E CONDITICN (GC OD, PCOR, HOLES) <br /> D=TH SOI- TYPE I CBS=-ZVATl"ON � SAMPLE r i <br /> 1 <br /> 4 i � <br /> I v j E I i <br /> j K 1 1 I <br /> I S I EYCAVAT20N SIZy x 17-MS OF SOS <br /> I A i <br /> M I DEPTH ISCIL =I- � OBSZRVATION <br /> � p P <br /> I Sao oova- vo o�GawQ!►�C�o,.� IFP- 5 I <br /> u <br /> P �, I ti ► � 'pp--�' i <br /> I I 3 I <br /> IGi - i <br /> on-E NSION ~ X X +� YDS OF SOIL <br /> j DEPTH TO G.N. : FT. SaMPs?''+IG METHOD I <br /> H � <br /> 2 r HOURS SIN= DEWATEPTNG: I <br /> 0 <br /> j OTH� SAMPLE: I <br /> i <br /> LABORATORY: � S?IM-PL�.-'4,5 NAL ': "C\�,�► G7EU.,A>R. <br /> f CLOSuRy LV PIAC2 ' 'EDRF'- VOLUME: <br /> ',-� 23-0043 (REV 2/23/94) ?ROVIME SI"I=' MA- <br />