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(U"L)ttU TANK CLU:.,URE/AUNDC,, 'NT IN"PEC:'T1 t1N <br /> (SHADED TO 13E FILLED IN FOR THE <br /> `'T TANK ONL Y) <br /> tith <br /> G i OWNERNAME khvi <br /> .-/-/ ✓ <br /> E 1(✓ f�r�r UN OWNER PHONE N <br /> IC C-7� L'7rr <br /> N f CONTRACTOR ;lorf <br /> CON. PHONEN <br /> E <br /> R f' SJLHD PE A� <br /> PERMIT EPA FIRE PERMIT <br /> N N <br /> A %t ''� ` s- <br /> � N lid <br /> � L <br /> : <br /> INSPECTOR <br /> c' DATE (C 6 TANK Y 39 <br /> R RINSED METHOD <br /> I Cl°J/-P_p rIlk RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST N <br /> -OR- OTHER <br /> Fpvk <br /> VAPORS PURGED/NjETHOD <br /> I�f AMOUNT USED L.E.L. READING AT REMOVAL (MUST BE < 20%) 3e"'16- <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALC3TEEL, FIBERGLASS, OTHER <br /> K C ) TANK SIZE <br /> / ? 0 TANK CONDITION OOD POOR, HOLES) <br /> P N <br /> I S 11 PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) It FEET <br /> �j P T /d f <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T I SAMPLE <br /> F A I i d 5f. <br /> -141 <br /> E K n (v <br /> L <br /> D EXCAVATION SIZE: X iii ` X 3-, YDS OF SOIL• <br /> - 7 i <br /> !!� A nramu S-A.L TYPE UHSERVATION <br /> SAMP-'L E <br /> P II <br /> P L P <br /> E I E <br /> C N <br /> r G TRENCH DIMENSION X X <br /> + I YDS OF SOIL <br /> 0 fi DEPTH TO C.W. : <br /> N FT SAMPLING METHOD <br /> 2 <br /> F-07 <br /> � I OF HOURS SINCE DEWATERING: <br /> 0 ( OTHER SAMPLE: <br /> LABORATORY: �'j�Pn� , r SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> DRAM' SITE NAP ON fteVERSE <br /> 4 Jf <br />