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oe- <br /> SJLifu - uNuriw,4wu/ru lnitn u......,....7R �d / Z <br /> (.SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> F r6 V; szst-goy <br /> G ; OWNER NA R OWNER PHONE <br /> E L /b <br /> N CONTR =OR / % c <br /> E EA/�l//t!F /N� CON. PHONEI ' X26 f75�`foo0 f <br /> R r SJLHD. PERMIT I A FIRE PERMITiV�' <br /> L . . . � � ` <br /> INSPECTO DATE �8 TANK 1 39 <br /> R RINSED Y N) METHOD n c� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 1 -OR- OTHER <br /> V VAPORS PURGED Y N) METHODLw ,ZC� 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 STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C DO �G <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) k FEET/�- � <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE k <br /> F <br /> A 74lL. <br /> I — <br /> N Y� r jue e 0 <br /> E K _ <br /> L <br /> D EXCAVATION SIZE: X YDS OF SOIL: 8 ) �� <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE 1 <br /> S P I h et/ <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS <br /> I OF SOIL <br /> 0 H DEPTH TO C.H. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY: C e SAMPLERS NAME: Oft-lCK <br /> CLOSURE IN PLACE MIXTURE. _ VOLUME: `c�c <br /> R1I Y.'1 04'1(7/RR1 DRAW SITE NAP ON REVERSE <br />