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SHADED AREA TU E FILLED IN FOR THE FIRST IK ONLY) S �b <br /> c x : <br /> J •.IV C . <br /> k1_46-4, <br /> R r' _ <br /> G OWNEf HE �' OWNER PHONE <br /> E /J'/� <br /> N CONTRACTOR JGM 7A4R �N- PHONES Z� <br /> EFIRE PERMIT <br /> R { SJLHD PERMIT I EPA <br /> A . . . . . . . . . . <br /> L <br /> DATE TANK 1 39 - <br /> INSPECTO <br /> RINSE AMOUNT <br /> R RINSED (Y/N) METHOD <br /> N RINSATE DISPOSAL SITE <br /> S t <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD 1XV <br /> AMOUNT USED fJ <br /> -A <br /> .P L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> O 4 <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) <br /> P N <br /> ILTI <br /> PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N SAMPLE # <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> I N <br /> E K / ` <br /> L YDS OF SOIL: <br /> D EXCAVATION SIZE: X X <br /> S= SAMPLE # <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M, P <br /> S P' I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING HE HOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> � Q[—OTHER SAMPLE: <br /> LABORATORY: �f Ij , rn� SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2:3 0,I3(7/88) <br /> 4 <br />