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HMI--H TO BE FILLED IN FOR THE FIRST"TANK�ONLY) <br /> ury <br /> cl <br /> EOWNER- NAME fc <br /> LLOG' � OWNER PHONE #C <br /> � Q 7- 33/ Q <br /> N ! CONTRACTOR ' i <br /> E " <br /> © CON. PHONE# <br /> R ". SJLHO PERMIT # EPA # <br /> A " FIRE PERMIT # <br /> J <br /> INSPECTOR E �2 Q <br /> S DATE 7*! D TANK <br /> R RINSED a/N) METHOD <br /> I RINSE AM NT6 O <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> i V VAPORS PURGED (Y N) METHOD <br /> A Ce AMOUNT USED 17 5 <br /> P L.£. L. READING AT REMOVAL (MUST BE '( 20%) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTEE FIBERGLASS, <br /> K C OTHER) TANK SIZE <br /> ! 0 TANK CONDITION (GOOD <br /> N , 00 HOLES) O �l� � -QZ.. A.t-CsAew, <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, <br /> P T OTHER) # FEE'( <br /> I PIPING CONDITION (GOOD, <br /> N POOR, HOLES) <br />� G <br /> DEPTH SOIL TYPE OBSERVATION <br />! F T SAMPLE # <br /> A <br /> I N <br /> E K t t bc) <br /> L <br /> D EXCAVATION SIZE: <br /> S X 1"j- X 1� YDS OF SOIL <br /> I ADEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> S P I <br /> i P L <br /> P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> O H DEPTH TO G. W. ; <br /> N a _ FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> EH 23043 ( 10!89) DRAW SITE MAP ON REVERSE <br />