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SJLHU - unU�1tC --� <br /> /UNU '1I11�I� �.LU VIIL//►�ywn . ..! ♦....a a. .. . ".. <br /> (SHADED AREA TO BE FILLED IN FOR TI/E FIRST TANK ONLY) <br /> s �G <br /> G OWNER NAME <br /> /2/16 N� OWNER PHONE 1 <br /> N CONTRACTOR 1 - CON <br /> E � P HONE M ' <br /> R SJLHD PERMIT 1 / <br /> Gy EPA N FIRE PERMIT 1 /3ct ���.� <br /> WI <br /> INSPECTOR,,/v/� t-t_f.v-< - DATE 9- a7 TANK 1 39 - / ' _ <br /> R RINSED (Y/ ) METHOD -- <br /> I � C RINSE AMOUNT • <br /> N RINSATE DISPOSAL SITE <br /> S (, <br /> E MANIFEST 1 -OR- OTHER <br /> ------------------ <br /> V VAPORS PURGED N) METHO <br /> •A DO <br /> 12 AMOUNT USED U <br /> • P L.E.L. READING AT REMOVAL (MUST E < 20%) <br /> 0 <br /> 'r FR COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE Q� <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /> P T 1 FEET <br /> i <br /> I PIPING CONDITION (GOOD, POOR, HOLES) ,r�,, <br /> N Y!e 7&- <br /> G DEPTH SOIL TYPE OBSERVATION - SAMPLE 1 <br /> T <br /> F A L L, _ <br /> I N i <br /> E K <br /> L <br /> D EXCAVATION SIZE: _�z X X YDS OF SOIL: <br /> 3• <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE 1 <br /> S p I <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO C.N. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF I4OURS SINCE DEWATERING: <br /> =13 E: <br /> .J r i SAMPLERS NAME: <br /> CLMIXTURE: VOLUME: <br /> .... ...- _ _ . - DRAW Srr>:+ Nan n►u d��►�.,..., <br />