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PUBLIC HE.2 i'a SERVICES-ENVIRONMENTAL H:LftLTH DIV=SION <br /> SITE NAME,j-- All <br /> I ADDRESS �.) � , CITY sf-C' <br /> OWNER NAME $' �,�u,rc. I OWNER PHONE <br /> CONTRACTOR [-Isc J9 _ CONT. PHONE ` <br /> FIRE PERMIT vi <br /> REMOVAL CLOSURE Lit PLACE TEMPORARY CLOS= <br /> INSPECTOR r 7h�U rSATE 3TANK 39 <br /> R RINSED FykV`J METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFESTOR OTHER <br /> V VAPORS PURGED CYJ <br /> N) METHOD P R I j GE—, AMOUNT USED <br /> I A <br /> P READING AT REMOVAL L.E.L. ` 02: <br /> O <br /> R 11COMMI&TS <br /> C TANK MATERIAL STE , FIBERGLASS, OTHER) <br /> N TANK CONDITION (GOOD, POOR, HOLES) <br /> S nz Ci <br /> T PIPE MATERIAL, ( STEEL; ,`IB GILASS, OTHER) <br /> PIPE CONDITION (GOOD, OUR, HOLx^�S@� Y .htE� �� <br /> 67 <br /> DEPTH SOIL TYPE IOBSZRVATION SAMPLE irz <br /> T � <br /> A <br /> N � - <br /> K <br /> S EXCAVATION SIZE X X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE i-ro' <br /> P P <br /> L I _ <br /> I P Q <br /> N E { <br /> G d oig3 <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 af HOURS SINCE DEWATERING: <br /> a <br /> OTHER SAMPLE: <br /> LABORATORY: Cao Pri4 .1 �-�-�- SAMPLERS NAME: WhZ f lfe 4 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />