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?111; ;Ultlb L GS Uli I.- <br /> L <br /> It.1 I - 1, -, ,�- V.-I <br /> (SHADED ARL 4 BE FILLED IN FOR THE FI Ix f TANK ONLY) <br /> Ulm <br /> em-r Rcy 21c," <br /> OWNER NAME OWNER PHONE 9 <br /> N < CONTRACTORCON. PH ONE# , <br /> R SJLHD PERMIT I EPA FIRE PERMIT 0 <br /> A . . . . . . . . . . . . . . . . . V <br /> L U <br /> I NSPECTORGy,/< DATE TANK 1 39 7 <br /> R. RINSED (yN) METHOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGEDN) METHODo/ey AMOUNT USED <br /> .A (y� <br /> . P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL )FIBERGLASS, OTHER} TANK SIZE /2 <br /> 0 TANK CONDITION((GO(GOOD, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T I I <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N I I <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 0 <br /> T -1. At- <br /> A 11 ' s iAl0_6u_Ll 42 <br /> 4L, L21� <br /> E K <br /> D S Hl EXCAVATION SIZE: J7 x 35'x _z_L YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE IF <br /> N M P <br /> S P I <br /> P L P <br /> E <br /> C N <br /> T G TRENCH DIMENSION x — x YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> I OF HOURS SINCE DEWATERING: <br /> abTHER AMPLE: <br /> LABORATORY: (1A N SAMPLERS NAME: 10E L, <br /> z <br /> CLOSURE IN PLACE FMIXTURE: VOLUME: <br /> DRAW SITE HAP ON REVERSE <br /> .11 2:1 0,13(7/88) <br />