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SITE <br /> MITE ,Si�"°c ADDRESS �` CITY <br /> OWNER .✓� .0. OWNER PHONE a� <br /> �-y�z 3�-e f-7 7 <br /> CONTRACTOR (� cONT. PHONE ` <br /> FIRE PERMIT/ - 7 <br /> RM40VAL X CLOS=- IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE��_20 TANK # 39 y/f 41 <br /> 40 <br /> R RINSED (Y DD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E IMANIFEST OR OTHER <br /> V VAPORS PURGED (%N) (METHOD 2p 0 AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: <br /> 0 <br /> R CablMENTS <br /> C TANK MATERIAL (Sm- <br /> S ; FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD, POOR, ERt' , e <br /> T PIPE MATERIAL (ST='?L, FIBERGLASS, FEET/,/"/ � <br /> GR <br /> PIPE CONDITION GOOD POOR, HOLES) <br /> DEPTH SOIL `="SPE ! OBSERVATION SAMPLE <br /> T <br /> A <br /> I <br /> S EXCAVATION SIS X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL =E OBSERVATION SAMPLE <br /> P P <br /> L I <br /> I P <br /> N E I I <br /> f <br /> G <br /> TRENCH DIME.YSION X X YDS OF SOIL <br /> DEPTH TO G.Fr. :lD,L FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> OTHER SAMPLE.: �- ik c <br /> LABORATORY: SAMPLERS NAME: d <br /> CLOSURE IN PLACE M VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />