Laserfiche WebLink
PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION I'd <br /> SITE S;ff. DRESS L �� CITY <br /> o ER - ®� OWNER PHONE <br /> CONTRACTOR P �"� CONT. PHONE go <br /> FIRE PERMIT <br /> REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTO DATE ANK 39 S <br /> R RINSED (Y& METHODA,� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S G <br /> E MANIFEST # Gl G U Y OR OTHER <br /> V VAPORS PURGED Y/ ) METHOD / C AMOUNT USED <br /> A <br /> P READING AT REMOVAL L.E.L. : 02: ► .�. <br /> O <br /> R COMMENTS <br /> C TANK MATERIAL (ST EL IBERGLAS , OTHER) <br /> ! <br /> O <br /> N TANK CONDITION (GOOD, POOR, HOLES) <br /> S <br /> T PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> PIPE CONDITION (GOOD POOR, HOLES) <br /> DEPTH/ SOIL TYPE OBSERVATION SAMPLE ` <br /> T !- > , <br /> K <br /> S EXCAVATION SIZ X DS OF SOIL <br /> A 1 _�7 <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> P P /2pf••/ /V ® 5 3 3 <br /> L I �G cl o o <br /> I P <br /> G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : �FT. SAMPLING METHOD <br /> H <br /> 2 HOURS SINCE DEWATERING: <br /> 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME4 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />