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iY <br /> • 1 7 //[} <br /> 110 55 1 <br /> G OWNER NAME <br /> f <br /> OWNER PIF30NE # <br /> E <br /> N CONTRACTOR CON. PHONEl S/ <br /> d E i3 <br /> r: R SJLHD PERMIT I EPA # FIRE PERMIT � <br /> L ; <br /> I NSPECTOR DATE yI / TANK # 39 <br /> R RINSED (!�N) METHOD `� � RINSE AMOUNT <br /> z <br /> N RINSATE DISPOSAL SITE LZ <br /> S <br /> E MANIFEST —OR—� OTHER <br /> V VAPORS PURGED (�N) METHODC AMOUNT USED f/l /gip <br /> A `" !� . <br /> P L.E.L. READING AT REMOVAL (MUST BE <1 120%) w A <br /> 0 <br /> T R COMMENTS <br /> A q <br /> N TANK MATERIAL (STEEL, FIBERGLASS, rOTHER) TANK SIZE <br /> KC —..._.._ j <br /> / O TANK CONDITION (GOOD rp�&' <br /> HOLES— <br /> P N <br /> I US PIPE MATERIAL ('STEEL FIBERGLASS, OTHER) # FEkiP IPIPING CONDITION (GOOD, POOR HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION ;'f SAMPLE I <br /> T <br /> I N <br /> E K <br /> L i. <br /> D EXCAVATION SIZE: X X / L YDS OF SOIL: <br /> S__ <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I r <br /> E I E <br />' C N <br /> E. T G TRENCH DIMENSION _� X / X YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 � <br /> 0 # OF HOURS SINCE DEWATERING: <br /> Fo 11 OTHER SAMPLE: ' <br /> 1 <br /> LABORATORY: ( ,•,cam II SAMPLERS NAME: <br /> c <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> .DRAW SITE MAP ON REVERSE <br /> Ii <br />