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'wj:0v0&rDr"1 Ivp I v <br />ff- I• <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />Psm FrIvi"Nalm Mr, <br />OWNER NAME ehgry� <br />OWNER PHONE <br />WORM <br />CONT. PHONE <br />REMOVAL CLOSURE IN PLACE <br />TEMPORARY CLOSURE <br />INSPECTOR <br />DATE <br />40f <br />TANK 3 9 17�a <br />iRINSATE DISPOSAL SITE <br />MANIFEST OR OTHER <br />VAPORS PURGED <br />READING AT REMOVAL <br />';TANK CONDITION (GOOD, <br />POIT <br />:!PIPE MATERIAL (STEEL, <br />FIBERGLASS, OTH <br />,PIPE CONDITION (GOOD, <br />POOR, HOLES) <br />OBSERVATION <br />SAMPLE <br />EXCAVATION SIZE x x <br />lliYDS <br />OF SOIL <br />0 <br />OBSERVATION <br />SAMPLE m I <br />TRENCH DIMENSION x <br />x IYDS OF SOIL <br />11 lob <br />HOURS SINCE DEWATERING: <br />LABORATORY: <br />CLOSURE IN PLACEI .�J■��14�� <br />■ <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />