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"J'v"'lq<uuNL 1'Aar, CLUSUIci/A4ANDONMKN'1' INSPECTION <br />(SHADED ARE, 'O BE FILLED IN Fna mur, vi <br />DRAW SITE MAP ON REVERSE <br />s <br />b <br />nn vrvt 1 / <br />-7 <br />-74 <br />(NAME <br />G <br />E <br />s OWNER <br />, OWNER PHONE # 57 _ <br />E <br />< CONTRACTOR CON. PHONE# a <br />R <br />A <br />SJLHD PERMIT # EPA # FIRE PERMIT # <br />L <br />_ <br />INSPECTOR DATE -7 TANK # 39,' <br />P-; <br />! , -7fi <br />R RINSED (YIN) METHOD RINSE AMOUNTlD4S <br />I <br />N RINSATE DISPOSAL SITE QRS <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED (YIN) METHOD AMOUNT USED <br />A <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T <br />R COMMENTS <br />A <br />N <br />K <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />P <br />N <br />I <br />P <br />S <br />T <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />T <br />DEPTH SOIL TYPE <br />OBSERVATION SAMPLE # <br />F <br />A <br />I <br />N <br />S <br />E <br />K <br />L <br />D <br />S <br />EXCAVATION SIZE: ILIX Cj�X <br />YDS OF SOIL: <br />I <br />N <br />A <br />M <br />P <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />— <br />0 <br />H <br />DEPTH TO G.W.: FT SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />s <br />b <br />