Laserfiche WebLink
DRAW SITE MAP ON REVERSE <br />TJf( <br />9Yw__ <br />2Ys <br />�;Ue V <br />yyC�,�fj> j�Uo <br />KC• ,I Maw <br />` <br />I _S( <br />G <br />E <br />OWNER NAME o, o F 17 <br />OWNER PHONE # <br />N <br />;CONTRACTOR S M!A <br />CON. PHONE# <br />R <br />SJLHD PERMIT # EPA # F I+RE DEPT— <br />L <br />N <br />SJLHD INSPECTOR <br />TANK # 39 <br />R <br />RINSED (YIN) <br />METHOD <br />RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (YIN) <br />METHOD <br />AMOUNT USED <br />A <br />P <br />_ ---- — — <br />L.E.L. READING AT REMOVAL (MUST BE < 208) <br />0 <br />- - - <br />T <br />A <br />R <br />COMMENTS <br />N <br />TANK MATERIA (STEEL, FIBERGLASS, OTHER) <br />TANK bIZE`3� <br />/ <br />P <br />0 <br />N- <br />TANK CONDITION (GOOD, POOR, HOLES) <br />- <br />I <br />S <br />--.-_.__..._...._Ip_ <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER)# FEET <br />P <br />T <br />-_ <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />-- -- - <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T- <br />- <br />- -- - <br />F <br />A <br />I <br />N <br />_ <br />-- <br />E <br />L <br />D <br />p <br />(--------- —[ 'tea s <br />EXCAVATION SIZE: YDS OF SOIL• <br />I <br />S <br />!� IS l` / � <br />I <br />A <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE # <br />N <br />M <br />P <br />SP <br />I <br />- --- .....--- - -- -- <br />-- <br />P <br />L <br />P <br />E <br />I <br />E <br />--------- -- --- <br />- <br />C <br />N <br />----... - r - <br />T <br />G <br />TRENCH DIMENSIONS: YDS OF SOIL: <br />1.--- <br />I <br />1 <br />- <br />0H <br />DEPTH TO G.W.:,+j� FT SAMPLING METHOD <br />N2 <br />------ ...-. --..__ ._..... _. __........_....-_. <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE: <br />HiLABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE I <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />TJf( <br />9Yw__ <br />