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1NL;PLCTlUll <br /> (SHADED A A TO DE FILLED IN FOR THE RST TANK ONLY) <br /> x <br /> FE G < OWNER MQ OWNER PHONE gCaO� <br /> N ? CONTRACTOR CON. PHONE# <br /> E ' <br /> R ! SJLHD PERMIT I EPA # �6D&' 1fi.1 FIRE PERMIT # <br /> LHIM <br /> �`�j�k�gjve��/loulw <br /> INSPECTOR / i �cl 1�P DATE TANK # 39 <br /> R RINSED (Ya <br /> METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST @ -OR- OTHER <br /> V VAPORS PURGED ( Y N) METHOD AMOUNT USED <br /> A <br /> P L .E.L. READING AT REMOVAL (MUST B'&/ < 20%) <br /> 0 <br /> R COMMENTS ° <br /> fr <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL ( STEEL, IBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD 00� HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: Ia X X YDS OF SOIL : <br /> S- <br /> I A DEPTH 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 /> 0H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> Hi a <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 1111 2'i 04.1(7/ki8) <br />