Laserfiche WebLink
f .. ,. � � A Y -- .. l.I.VJI .\l+I ttl.�I�bl/1 1^�. V♦ 1c.JYL'L.t1V1V � <br /> (SHADED Al TO BE FILLED IN FOR THE T TANK ONLY) <br /> G < OWNER NAME OWNER PHONE # <br /> E <br /> N < CONTRACTOR = ( L CON. PHONE# y l6 c _ 8(0 6E W 1 . <br /> R SJLHD PERMIT N EPA N FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR kA�11DATEk ai �1�7TANK N 39 <br /> R RINSED Y rr /N) METHOD - RINSE AMOUNT <br /> I C <br /> N RINSATE DISPOSAL SITEVQA <br /> S <br /> E MANIFEST N 7. -OR- OTHER <br /> V VAPORS PURGED WN) METHODAMOUNT USED <br /> t <br /> A <br /> f P L.E.L.. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br />�• T R COMMENTS <br /> A <br /> K C TANK MATERIAL STEEL, FIBERGLASS, ; OTHER) I TANK SIZE <br /> / 0 TANK CONDITION "GOOD,,' POOR, HOLES) <br /> P N <br /> I S PIPE MATERIALFIBERCLASSt ' OTHER)7 # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N 1 11 <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> _ r <br /> I N C l e: - - -- 7_S <br /> -_ <br /> ` ,� s •-,,'. , Ji.__ -_ ;r S.- fib- _ <br /> E K <br /> L <br /> D EXCAVATION. SIZE: X IL X•�j. YDS OF SOIL: <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE N <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 /> 0 H DEPTH TO G.W. : FTSAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER. SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON ,REVERSE <br />