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SJLllD - UNJOGROUND YANK C;L0"UliE'1 ALVML*-Jk:la'1' lNL;VL;C;'1'! uj4 <br /> (SHADED AREA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br /> R" <br /> . .r4 moi.• <br /> G OWNER NAME �� / ' �/r OWNER PHONE 0 <br /> N CONTRACTOR CON. PHONE# - <br /> E - <br /> R e SJLHD PERMIT I EPA M FIRE PERMIT 0 <br /> am <br /> INSPECTOR '` , ,,' DATE _;� ) TANK Y 39 - <br /> R RINSED Y N) <br /> I METHOD , RINSE AMOUNT <br /> • <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED WN) METHOD�`� AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20t) l ' <br /> 0 b�v'��, <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL) FIBERGLASS, OTHER) TANK SIZE <br /> K C 7 6' <br /> / 0 TANK CONDITION (GOOD,'" POO[ ), HOLES) <br /> P N - <br /> I S PIPE MATERIAL . (STEEt' FIBERGLASS, OTHER} V FEET f <br /> P T � a� � . <br /> I PIPING CONDITION (GOOD:, POOR,) HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE U <br /> F -S <br /> _ <br /> I Al <br /> E K <br /> L <br /> D EXCAVATION SIZE: X r <br /> S- � X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <br /> S P I A- U ��_ c: C � «(� t A2_� - <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 /> 0 OF HOURS SINCE DEWATERING: <br /> i3 OTHER SAMPLE: <br /> LABORATORY: (/?t)LL �� SAMPLERS NAME: , a, <br /> i <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 2:1 0Ct(7/Sri) DRAW SITE MAP ON REVERSE <br />