Laserfiche WebLink
(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />ar1WAMr�r ZMVAa armor �rc�,r�ai i�Lr>�r�%s6rcrwar'u%'.r�% <br />.•�� s � c s r+i <br />OWNER NAME OWNER PHONE <br />iV CONTRACTOR CON. PHONE* <br />c <br />R SSLHD PERMIT ## EPA FIRE PERMIT <br />A r6t6 / 6to �6 G lrtG dl!i 6. <br />L rc cT G H t , uau ae :6 t+ i-+ ► c►� rc C� u r% <br />INSP£ DATE _9 TANK 39 — — <br />R i R I NSE (Y! ) METRO / ' / RINSE AMOUNT <br />z,�Ae, Z., <br />+ I <br />N RINSATE DISPOSAL SITE i <br />S i <br />' E MANIFEST # -OR- OTHER <br />c V VAPORS PURGED Y/N) METHGD,L ` AMCUMT USED <br />+ A <br />P 1 L.E.L. READING AT REMOVAL (MUST B-< io- n) <br />0 <br />T ; R COMMENTS <br />A � I <br />I <br />N i ! TANK MATERIAL (STB=L FIBERGLASS, OTHER) TANK SIDE <br />;{ r <br />f O TANK CONDITIO <br />A4•�Ni N ' <br />. S PIPE MATERIAL CSTEELFIBERGLASS OTHER) FEET <br />P T <br />L i PIPING CGNDITION (Gd'0D,LOOR9 HOLES) <br />w <br />i <br />G E i DEPTH SOIL ► _ OBSERVATION SAMPLE <br />s � T I <br />4' 1 <br />I IN <br />K <br />L <br />D EXCAVATION SIZE: X X I YDS OF SOIL: I' <br />i S i + <br />I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br />N M ' P <br />S P I 1 - <br />P L 1 P <br />C + N i1 <br />IG ; TRENCH DIMENSION X X YDS OF SOIL <br />I <br />0 i H DEPTH TO G. °W.: FT SAMPLING METHOD <br />N i <br />Q f OF HOURS S I NCE. DEWATERING: <br />t <br />I <br />j I O i OTHER SAMPLE: I <br />, <br />LABORATORY: 5LERS NAME: <br />► CLOSURE IN PLACE MIXTURE: �. VOLUME: I <br />�H 2�4=►;; C1�)/89J DRAW SITE MAP ON REVERSE. <br />