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(SHADED AREA D BE FILLED IN FOR THE FIR3'TT TANK ONLY) <br /> G OWNER�F ME �' 7 OWNER PHONE I <br /> E <br /> N < CONTRACTOR JG/M ZSR P -CON. PHONES Z� / <br /> E <br /> R < SJLHD PERMIT I EPA I FIRE PERMIT <br /> L .'' <br /> I NSPECTOF�V, DATE/� Z���/ TANK ! 39 - y - <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST B < 203) i <br /> O <br /> T R COMMENTS <br /> A � <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD, POOR HOLES) j <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) t FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> NSAMPLE # <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> I N <br /> E K <br /> I` YDS OF SOIL: <br /> D EXCAVATION SIZE: X X j <br /> S- SAMPLE II• <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> -------------------- <br /> C N <br /> T G TRENCH DIMENSION X , X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.H. : FT -It, SAMPLING <br /> N 0 I OF HOURS SINCE DEWATERING: <br /> Fo� OTHER SAMPLE <br /> LABORATORY: r f 0 I �i� SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: ' <br /> DRAW SITE HAP ON REVERSE <br /> Fit 2:1 043(7/88) <br />