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SJLHV - VNVh;h hUVK4� 1HNn LLVJVRL/ tft tiv Vls tvi tt tA aa•✓c alv.. <br /> (SHADED AREA BE FILLED IN FOR THE FIR`' '"ANK ONLY) <br /> G OWNER NAME OWNER PHONE <br /> E <br /> N < CONTRACTOR CON . PHONE# <br /> E - - <br /> R SJLHD PERMIT # - EPA # -- FIRE PERMIT # <br /> L <br /> INSPECTOR ,5 DATE TANK # 39 - OD a a S 3 - 000 / <br /> R RINSED (Y N METHOD I RINSE. AMOUNT <br /> I -"G✓1 7tcH.�` .� <br /> N RINSATE DISPOSAL SITE <br /> S -- <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD AMOUNT USED <br /> I <br /> I A <br /> P L .E. L . READING AT REMOVAL (MUST BE < 20t ) <br /> O - <br /> T R COMMENTS <br /> N TANK MATERIAL ( STEEL, FIBERGLASS, OTHER ) SZF � <br /> K C - <br /> / O TANK CONDITION (GOOD, POOR, HOLES ) u <br /> P N - <br /> I LS PIPE MATERIAL ( STEEL, FIBERGLASS, OTHER ) # FEET <br /> P J <br /> I J1 PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T - t - <br /> F A i Ve - <br /> I N 0- <br /> E K <br /> L <br /> D EXCAVATION SIZE: 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 XYDS OF SOIL v <br /> I <br /> O H DEPTH TO G.W. : Cp FT SAMPLING MET O <br /> 0 # OF HOURS SINCE DEWATERING: <br /> no <br /> OTHER SAMPLE: - <br /> LABORATORY: `' ` �' � SAMPLERS NAME: <br /> U_CLOSURE IN PLACE M XTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />