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•Y,�fO1T1` A./ <br /> C1LG'10.14'QYIr/�IO'!!�!D'�VVlO'IU <br /> , <br /> JO'! lVlA" <br /> OWNER �MEEL&N ( I CWNER PHONE _ -3-7 <br /> -7 A3� 0 <br /> N J <br /> CONTRACTOR d . CCN. PHGNE* so' ✓ <br /> R r S.7LHD PERM 17 EPA daD/ $�� FIRE PERMIT 4 �p <br /> GIG �i6 lGi <br /> L rc vr� �, a circ s� Y iil.= 1 tip « C!..uS�u�cl✓llrG 1GG .cG. <br /> T_NSFS DATE _ �c3 TANK 4 39 - 6 <br /> R i RINSED' N) METHOD ! �Q S2 RINSE AMOUNT / Z <br /> i IAli <br /> N RINSATE OISPOSrAL SITE r se <br /> F <br /> S � i.lezre5 <br /> MAN Z;EST -OR- OTHER <br /> V VAPORS PURGED `�/ ) ( METHOD 02 e I AMCL:MT USED SAO <br /> A } <br /> P L. E. L. READING AT REMCVAL (MUST BE < Ear) = G �L <br /> 0 _ <br /> T i R COMMENTS <br /> A <br /> N ; TANK MAT=RZAL STc= FIBERGLASS, OTHER) � TANK S: /�QQ Gam- <br /> { C <br />} / O TANK CONDITION GCC POOR, HOLES) <br /> 5 i P_TPE AIATERiAL F IBERGLASS, O T.iER) FE=iQ <br /> 1 P T <br /> PIPrNG CONDITION (GOOD POOR, HOLES) <br /> G DEPTHI SCIL TYPE OBSERVATION I SAMGL E Tr <br /> A <br /> I 1 wN. 66 6o2 1 r I <br /> I N 1 GL Ydw v k- 1 / <br /> L I �✓.✓. .TGr <br /> D EXCAVATION Srz: XX YDS OF SOIL: <br /> I S s -� <br /> I A j DEPTH SOIL TYPE I OBSERVATION I SAMPLE <br /> M P 1 I I I <br /> S P r j <br /> P L P <br /> C i N I I 1 <br /> I G TRENCH DIMENSION X X YDS OF SOIL <br /> y <br /> 0 H DEPTH TO G. W. 00 FT I SAMPLING METHOD <br /> 0 OF HOURS SINCE CEWAT=RING: <br /> C <br /> OTHER SAMPLE: <br /> l f <br /> LABORATORY: A.( � I SAMPLERS NAME: �'Z— <br /> CLCSURE IN PUgCE ' M:XTUrcS: I. VOLUME: <br /> H <br /> 2-014-7 (10/89) ORAW Si T c MAP ON REVERSE . <br />