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noiuv – Uc1UP.KUhUU114U 'lhr4m CLOSUHL/A4ANDONME111T 1146YEC'1'lON <br /> (SHADED ARjj TO BE FILLED IN FOR THE I&ST TANK ONLY) <br /> G < OWNER NAME �C OWNER PHONE # <br /> E <br /> N < CONTRACTORS CON. PHONE# <br /> E <br /> R < SJLHD PERMIT # EPA # `moo` FIRE PERMIT # <br /> L <br /> INSPECTOR U DATE C4 (7 g 18�� TANK # 39 <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD j3 (% 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 �_ zy,( <br /> / 0 TANK CONDITION (GOOD, POOR, ' HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K f <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P 1 <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION _—X _'X YDS OF SOIL - <br /> I <br /> 0 mo <br /> DEPTH TO G.W. : V�Orl FT SAMPLING METHOD <br /> # OF HOURS SINCE DEWATERIN 1 111 <br /> ❑0 OTHER SAMPLE: �– 7 <br /> LABORATORY: CB)0c' SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: -- VOLUME: — - - <br /> DRAW SITE MAP ON REVERSE <br />