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. .i{ . V 1'/►tJK 1�LOSUf{k,/AIU1tJD0t3M1::td 3' ltl.`.;f. �.l�°l"l UN <br /> c ' 0SiHE' TO BE FILLED IN FOR TtiIr FJJWT TANK ONLY) <br /> ]N '� -OWNER NAME R t'3 L. OWNER PHONE o � <br /> c0 �Ce�hccc°, <br /> CONTRACTOCON. PHONCq SJLHD PERMIT I EPA !f FIRE PERMIT 9 jL li1 . i <br /> INSPECTOR -T DATE 3 � S` TANK Y 39 — 573 -- O� . <br /> R RINSED 0/ <br /> METHODRINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST It --OR— OTHER <br /> V VAPORS PURGED 2N) METHO AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST GE < 20%) 3 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE FIBERGLASS, UTHLR) TANK SIZE <br /> K C <br /> 0 TANK CONDITION G0 POOR, HOLES) <br /> P N <br /> I <br /> LT PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) % W FEET <br /> PIPING CONDITION (GOOD, POOR, HOLES ) D'_ <br /> G 7�` DEPTH SOIL TYPE OBSERVATION SAMPLE 0 <br /> ., »� - _ <br /> I N CA Amta 15 <br /> E K <br /> L <br /> D EXCAVATION SIZE: ILI X 5 X � C) 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 /> N2 DEPTH TO G.W. :X03L� UtCe6t SAMPLING METHOD <br /> �0 OF HOURS SINCE DEWATERING: <br /> O I QTHER SAMPLE: <br /> t <br /> LABORATORY: � SAMPLERS NAME'. <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE NAP ON REVERSE <br /> 111 ')3 OVI(7/88) <br />