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(SHADED APIA TO DE FILLED IN FOR THE vIRST TANK ONLY) <br /> G < OWNER NAMESI z y0 ' N S OWNER PHO WE <br /> E <br /> N CONTRACTOR gni CON. PHONE# r�A <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A . <br /> L <br /> INSPECTOR , �� DATE s ?; TANK # 39 <br /> R RINSED (Y/N) METHOD , U RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S .,. �. <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (YIN) METHODr(, 2r rj,� icc 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 000 <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET,--,?, _ E <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N ° 21A1 <br /> E K <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 <br /> S P I i. i r� /✓/ , <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 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 --- <br /> 01 OF HOURS SINCE DEWATERING: <br /> 07OTHER SAMPLE: <br /> LABORATORY: ( • SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />