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PUBLIC HES,' SERVICES-ENVIRONMENTAL HF 'H DIVISION <br /> SITE SfUC vtic.�-�t t I ADDRESS.5 1 b F ��(C� CITY <br /> ; OWNER NAME `OWNER PHONE J <br /> I CONTRACTOR 17E;l�l��G -�'l I CONT. PHONE ���L f� c 'Y.� 5 Q_1 <br /> I <br /> ; FIRE PERMIT J <br /> REMOVAL_ CLOSURE =Y PLACE TEMPORARY CLOSURE <br /> I _ I <br /> rT^ CCS i/r G l <br /> INSPECTOR DATE - < TANK 39 � ! 6 `3 <br /> ) <br /> ��- HORTTSE AX0 'NT <br /> R RINSED (YD nJ <br /> ! I <br /> N RINSATE DISPOSAL SITE <br /> I <br /> 2-: <br /> MANIFEST OR OTHER <br /> V VAPORS PURGED {Y�N) METHOD (AMOUNT USED 3 �vL'i <br /> i <br /> P READING AT R—EMOVAL L.E.L. : ``u I 02: <br /> 0 <br /> > / I <br /> R COMMENTS <br /> C TANK MAT=kL (STEEL, r IBE.RGLAS , OTHER) <br /> N TANK CONDITION G9 , POOR, HOLES) ';.;I i'�'L&�� � <br /> ! S <br /> T PIPE MATE=-kL((STS-E�'T;, r IB GLASS, OTHER) FEET �f- <br /> i i <br /> PIPE CONDITION (GOODHOLES) `1 �` ' �� ' � �! til' <br /> I DE.�TH I SOIL TY?. I OBS'r:.RVATION I SAMPLE <br /> i A I <br /> I <br /> N <br /> S EXCAVATION SIZE X YDS OF SOIL <br /> A <br /> M DEPTH SOLI TYPE (OBSERVATION SAMPLE <br /> P P I , 4- / f <br /> I P <br /> C I I <br /> G <br /> TRENCH DIMENSICH X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DLAATERING: <br /> 0 HER _ � <br /> OTAMPLE: l \P t ie_ S p 6J E <br /> SAMPLERS NAME: <br /> t <br /> LABORATORY: I <br /> CLOSURE IN PLACE I =URE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />