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Z- �- <br /> Cfita <br /> G ti OWNER NAME I OWNER PHONE # <br /> E _ <br /> N ti CONTRACTOR <br /> CON. PHONE# <br /> E <br /> R f SJLHD PERMIT # ]`[ EPA #�j�j FIRE DEPT <br /> SJLHD INSPECTORq- � �' ��� TANK # 39 <br /> —_._ _—.- - 1---— ---_--- ---- <br /> R RINSED (Y� N) METHOD A' RINSE AMgC( ` <br /> N RINSATE DISPOSAL SITE �✓ �A <br /> S <br /> E MANIFEST -OR- OTHER <br /> ----_ -_...---.—._ - - -..__._._.__...:...._.___........._.... _...__......_....._._. ...._..__....__...._................_._....._..._...._..... <br /> V VAPORS PURGED �( N) METHODAMO USED <br /> A - L �<' .. <br /> t �N <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL ,("ST�FIBERGLASS, OTHER) TANK SI T$ �- <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, / OLES — - <br /> P N ......_.__.._.__. .�. <br /> I S PIPE MATERIAL ( EEI FIBERGLASS, OTHER ) L # FEET Z <br /> P T — LL <br /> I PIPING CONDITION (GOOD, /ec�0 HOLES ) --_ --� - _._....._._._____.__ <br /> N _ <br /> G DEPTH SOIL TYPE OBSERVATION -�— _ SAMPLE # <br /> T <br /> F A --,�--- -- -- __ ---- - <br /> I N <br /> -- -— -- -... --._...._........ <br /> _...... <br /> L _____._.__..._.__. _-__._...___.._. .... _. ...._... _. ...._.............._............ <br /> .._._....... <br /> D EXCAVATION SIZE: ----��' I YDS—OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P —_ _. ..._..... <br /> S P <br /> P L P <br /> E I JE <br /> C N <br /> T G TRENCH DIMENSIONS : YDS OF SOIL : <br /> 0 H DEPTH TO G.W. : FTSAMPLING METHOD <br /> N2 --- -----_._._.._......... __.—.....-- .._._..- .. _ _.. ........ _....... <br /> 0 # OF HOURS SINCE DEWATERING: <br /> DCTHER SAMPLE - — ___�-- ___--_ - ---- — ---- _-----=1 <br /> LABORATORY : <br /> _ - _ — -- SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE: — — I VOLUME: — — <br /> DRAW SITE MAP ON REVERSE <br />