Laserfiche WebLink
SJL)ic.• UNDERGROUND 'TANK (-LUSURL,/)i ANUUlpLel '1' 1NS1'LCTIUN <br /> (SHADF.D ARE—"''TO BE FILLED IN FOR THE- F' ')'T TANK ONLY) <br /> G < OWNER NAME OWNER PHONE 0 0011*1 <br /> -732 <br /> OE <br /> N CONTRACTOR CON. PHONEY <br /> E <br /> R t SJLHD PERMIT I EPA N FIRE PERMIT 6 <br /> A � iK • <br /> Is <br /> INSPECTOR DATE /3 ��� TANK M 39 —jaV — <br /> R RINSED (Y/ METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I .-OR- .. OTHER <br /> V VAPORS PURGED /N) METHOD AMOUNT U E <br /> .A <br /> .P L.E.L. READING AT REMOVAL! '(MUST B7 < 20%) ` . <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C M <br /> / 0 TANK CONDITION (GOOD, POO HOLES) oZ .yL G <br /> P N <br /> I LS PIPE MATERIAL (STEEL, FI`BERGLASS., OTHE ) ;�FE TP IPIPING CONDITION (GOOD, POOR, HOLES) � •, <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> T S of <br /> F A �1 AA O <br /> I NJid <br /> E K <br /> L <br /> D EXCAVATION SIZE: L4— 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 EQ 42 <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 I OF HOURS SINCE DEWATERING: <br /> Fo 11 <br /> OTHER SAMPLE: <br /> s <br /> LABORATORY: SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: VOLUME: ` <br /> DRAW SITE MAP ON'REVERSE' <br /> EH 2:1 043(7/88) <br /> qR <br />