Laserfiche WebLink
N <br />R <br />A <br />L <br />OWNER NAME -1 2_1 1;(,,4 iA L,,,- \..I , .__N CWNER PHONE # -1 l2n 1 -.a <br />7)0 <br />CONTRACTO / <br />Vv) I CCN. PHONE# <br />S,TLHD PERMIT # I I�0�2t I FIR£ PERMIT <br />/` � rtc:�Gv�r.i � uS�uttt��V r t,.c !G 16 iG <br />i ctu rti u:.w�urt!✓ <br />INSPECTOR DATE I TANK # 39 — — <br />iA <br />R RINSE]'( N) I METHOD N 1e RINSE AMOUNT 1--l—, <br />N <br />RINSAT= D:SPCSAL SITE v <br />S <br />i <br />E <br />MANIFcST # —OR— 0in7ER <br />V <br />VAPORS PURGED (Y/N) I METHOD I AMCL47 USED 20 <br />P <br />0 <br />L.E.L. READING AT RMMOVAL (MUST BE ( 20%)/J <br />R <br />CCMMENTS 07y _ 7 <br />TANK MATERIAL (STcn_,) FI3ERGLASS, 0717RT_J _TANK S.IZE -t-., <br />O <br />_a <br />i 7 _ i <br />0 <br />TANK CONDIIICN (GCOD, POCK, HCL=S) <br />N <br />I r <br />S <br />PIPE MATERIAL IC'S TE=',_FIBERGL,^SS, Oi x FEE i <br />T <br />PIPING CONDITICN GOOD POOR, HOLES) <br />I <br />DEPTH I SCIL TYPE I OBSERVATION SAMPLE w j <br />A <br />J I <br />N <br />K <br />I I / 1 <br />1 <br />I I <br />=AVATION SIZE: 6 X X YDS OF SOIL: <br />S <br />— <br />A <br />DEPTH I SOIL TYPE I OBSERVAT!ON I SAMPLE # <br />M <br />P <br />I I <br />P <br />11 <br />I I I <br />L <br />P <br />I I I 1 <br />T 1 <br />C <br />I I I <br />N <br />TRENCH DIMENS:CN X X YDS OF SOIL <br />G <br />H <br />DEPTH TO G. W. FT I SAMPLING METHOD <br />2 <br />0 <br />0 OF HOURS SINCE DE'AAT=RING: <br />i <br />0 <br />OTHER SAMPLE: <br />LABORAATORY:I <br />SAMPLERS NAi+ � <br />CLCSUP.S IN PLACE <br />I MIXTURE: I VOLUME: <br />DRAW SITE MAP ON REVERSE. <br />I <br />