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..0 LLJ - vIYJL(\ul\J JIYJ 1..... LLJJ L.<L•/IlLu1L\UUIV.a..l 1..J1'61.11 V1V <br /> (SHADED A4N TO BE FILLED IN FOR THE WST TANK ONLY) <br /> r' �N�e StxN <br /> T <br /> G OWNER NAME (aClt OWNER PHONE # <br /> � E <br /> N L CONTRACTORCrI> vS ON CON. PHONE# ZO / 82� <br /> E <br /> R SJLHD PERMIT I EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR e �Nf DATE $ Zy TANK # 39 <br /> R RINSED (Y N) METHOD -/, 5f, RINSE AMOUNT_,,S � <br /> I � < <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGE (Y ) METHOD Q AMOUNT USED /Sd/�5. <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) NoNP <br /> 0 <br /> T R COMMENTS <br /> A "r <br /> N TANK MATERIA ( STEEL FIBERGLASS, OTHER) TANK SIZE UDC7 <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIALSTEEL, 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 C h7/ <br /> I N _ G lLa xolo A is N rn. drs rrSPr <br /> E K iS� CIorC <br /> L I (l <br /> D EXCAVATION SIZE: -Lo X X YDS OF SOIL : <br /> 3: <br /> I ADEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <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 /> OH DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> UFo-11 <br /> OTHER SAMPLE: <br /> LABORATORY: fGL SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> E(( 23 043(7/88) <br />