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"- t '�•�-- 11..... 114 k'1J;CTIUN <br /> (SHADED ARF- TO BE FILLED IN FOR THE F -ST TANK ONLY) <br /> G OWNER NAME OWNER PHONE # <br /> E <br /> N < CONTRACTOR CON. PHONE# <br /> E <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR � . _� DATE TANK # 39 - �i� - Q3 <br /> R RINSED (Y%N) METHODIr<Plz Zwx RINSE AMOUNT �5 i <br /> I <br /> N RINSATE DISPOSAL SITE b � <br /> S L� <br /> E MANIFEST # -OR- OTHER <br /> AVAPORS PURGED Y N) METHOD ��� � AMOUNT USED��� ��� <br /> P L .E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL (STEEL, IBERGLA , OTHER) TANK SIZE/L ()DQ U.L. <br /> / 0 TANK CONDITION OOD POOR, HOLES ) C1 <br /> P N <br /> I S PIPE MATERIAL (STEEL, F BERGLASS, OTHER) # FEET 1 <br /> P T <br /> I PIPING CONDITION GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH jgSOIL TYPE OBSERVATION SAMPLE # <br /> T - a x e <br /> F A <br /> I N 5- <br /> E K <br /> L <br /> D EXCAVATION SIZE: >LYrX X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P 5 - <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X Z X YDS OF SOIL <br /> I <br /> ' 0 H EDPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 OF HOURS SINCE DEWATERING: <br /> ❑0 OTHER SAMPLE: <br /> LABORATORY: G- c- SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 1311 23 043(7/88) DRAW SITE MAP ON REVERSE <br />