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PUBLIC "tV--*H SERVICES-ENVIRONKMAL #TH DIVISION <br />SITE NAME <br />GVi s 1 yp <br />ADDRESS 5?3 2,/ n f . w,� a <br />CITY S ,�,� <br />OWNER NAMEO Cyt �, <br />I OWNER PHONE 2.27 5 _ 7 � - 71 5 SZo - 6 7-s <br />CONTRACTOR N + I .S ' wC <br />CONT. PHONE <br />FIRE PERMIT 0 <br />S <br />REMOCLOSURE IN PLACE TEMPORARY CLOSURE <br />INSPECTOR t%T �- DATE y /c� .� (� TANK 0 39 -17- 6 <br />R RINSED / ) METHOD RINSE AMOUNT 3 p <br />I <br />N <br />RINSATE DISPOSAL SITE Oj <br />S <br />E <br />MANIFEST , OR OTHER <br />V <br />A <br />P <br />0 <br />R j <br />VAPORS PURGED &N) METHOD(J ; AMOUNT USED / %6, <br />READING AT REMOVAL L.E.L.: / 02: Z <br />COMMENTS v -- <br />C <br />TANK MATERIAL (STEEL,BERG , OTHER) <br />0 <br />N <br />S <br />T <br />TANK CONDITION (GOOD, ® , HOLES) <br />PIPE T (STEEL, F,B' G' S, OTHER) a FEET <br />PIPE CONDITION (GOOD, 00 , HOLES) <br />S <br />Tr <br />A <br />N <br />K <br />DEPTH SOIL TYPE OBSERVATION SAMPLE <br />zzry -�/ <br />i'a/h — Z <br />EXCAVATION SIZE X X <br />YDS OF SOIL <br />A <br />M <br />P <br />L <br />I <br />N <br />G <br />P <br />I <br />P <br />E <br />DEPTH SOIL TYPE OBSERVATION SAMPLE 0 <br />TRENCH DIMENSION X X YDS OF SOIL <br />LLOTHER <br />H <br />2 <br />0 <br />DEPTH TO G.W.: FT. SAMPLING METHOD <br />f HOURS SINCE DEWATERING: <br />SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: VOLUME: <br />EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />