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(SHADED ARr TO BE FILLED IN FOR THE F ST TANK ONLY) <br /> G <br /> OWNERNAMEOWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR b � DAT��TANK # 39 <br /> IRINSED) METHOD Tr< Pl �n RINSE AMOUNTd, <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGEDY N) 1 .METHOD �� ' � AMOUNT USED � � <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) -- <br /> 0 <br /> T R COMMENTS - <br /> A <br /> N TANK MATERIAL (STE L, IBERGLA , OTHER) TANK SIZE NQS <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) nc-) nclRp <br /> P N - <br /> I S PIPE MATERIAL (STEEL, FI ERGLAS , OTHER) # FEET <br /> P T _ <br /> I PIPING CONDITION00 , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A "t d <br /> I N ✓ 1bcnsi rid 7ePq S- <br /> E K S- <br /> L <br /> D EXCAVATION SIZE: � Y X X YDS OF SOIL: <br /> 3: — <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P o cmc , n <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION Z X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : — FT SAMPLING METHOD <br /> ---- <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: -- <br /> LABORATORY: CS L SAMPLERS NAME: CruLLij-., — <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> lI► 23 043(7/88) DRAW SITE MAP ON REVERSE <br />