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Jim Thorpe Oil, Inc. <br /> 351 N. Beckman Road ® P.O. Box 357 ® Lodi, CA 95241 <br /> (209) 368-6175 0 (209) 462-4581 <br /> Contractor's License 1495698 <br /> TRIPLE RINSE WORKSHEET <br /> Customer Name: Date:�_l f <br /> Site Address Billing Address:_ <br /> j EPA Site No g5/ Number of tanks: <br /> Gal. amt. Gal. amt. of <br /> 1 Size of I Tank sticking removed prior OR Exempt Rinsate <br /> Tank Product upon arrival to rins Tank ID1 _ _ Tank <br /> PrRemoved <br /> 2. <br /> Total amount removed Total amountof <br /> prior to rinsing __ gals. rinsate removedals <br /> Haste and rinsate removed by: � n/ c�.� EPA # --_-- <br /> Manifest # `ID Inv. <br /> Time: Left shop }�;G" Arrived on Site `Lb <br /> Left site A Arrived at Shop —:00 _ <br /> Rinse Technician <br />