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DRAW SITE MAP ON REVERSE <br />,IA <br />l <br />G <br />OWNER NAMEx-- OWNER PHONE # <br />N <br />E <br />° CONTRACTOR �L Mme`- CON. PHONE# -- --- ; <br />- ---- <br />R <br />SJLHD PERMIT # EPA # FIRE DEPT <br />s� <br />L <br />SJLHD INSPECTOR TANK # 39 <br />�y�C l_ - --� <br />R <br />RINSED (Y/N) METHOD <br />RINSE AMOUNT <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER - <br />V <br />VAPORS PURGED (Y/N) <br />METHOD Aye„ <br />AMOUNT,ED/`d� <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />---- - -- -- - - <br />T <br />R <br />COMMENTS <br />A <br />-- - -- ---_�_ <br />N <br />TANK MATERIA (STEEL, IBERGLASS, OTHER) <br />TANK SIZE-,;2.0(30 <br />K <br />C <br />- - <br />/ <br />0 <br />TANK CONDITIO OD, 4OR, HOLES) <br />PN <br />-- _... .. ..... -- -----._. _... _......- -----_...... __. <br />I <br />I <br />S <br />PIPE MATERI L (S EL IBERGLASS, OTHER) # FEET <br />P <br />T <br />- - - <br />I <br />PIPING CONDITION GOOD, POOR, HOLES) <br />N <br />-- <br />G <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE # <br />T <br />F <br />A <br />L Z <br />I <br />N <br />rt _......... - 0 •�- - - <br />-- .. - - <br />E <br />K <br />L <br />i✓ A/O Geo%GS' H✓ 7�/✓- -----,--------- ----- <br />D <br />S <br />EXCAVATION SIZE: l0 G YDS OF SOIL: �I <br />- <br />I <br />A <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE # <br />NM <br />P <br />--- - - <br />I _._....._. ....- , . ........ ... <br />_- _._._... _._.._..._._ <br />S <br />P <br />I <br />--------- - <br />---_ <br />P <br />L <br />P <br />--------- <br />------.-_._...__.... _..... . _........ .... <br />..... _......._......._.__....._._......_. <br />E <br />I <br />E <br />--- - <br />--- --- <br />C <br />N <br />- <br />T <br />G <br />TRENCH DIMENSIONS: <br />I YDS OF SOIL: <br />I <br />- --- <br />0 <br />H <br />---�T-----I_ <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N2__...__...._......._._....._ <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑0 <br />OTHER SAMPLE - - - <br />LABORATORY: <br />SAMPLERS NAME: - I <br />) <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />,IA <br />