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PHS <br /> NDON NT INSPECTION <br /> • (SHADED AREA 0 BE FILLED IN FOR THEJFIRST TANK ONLY) <br /> Sc f _ ii <br /> E OWNER NAME , <br /> OWNER PHONE # ' <br /> N CONTRACTOR � lI <br /> E CDN. PHONE# <br /> R SJLHD PERMIT # 11 <br /> v 3 <br /> A , ' EPA # 'FIRE. PERMIT # <br /> INSPECTOR DATE <br /> -2�.,01F1'/ TANK # 39 <br /> R RINSED „ <br /> I �) METHOD INS MOUNT <br /> N RINSATE DISPOSAL SITE ! <br /> E MANIFEST # <br /> f <br /> -OR- OTHER <br /> k V VAPORS PURGED Y ) METHOD <br /> A �rcye /'c AMOUNT USED <br /> P <br /> L. E. L. READING AT REMOVAL (MUST BE < 2 <br /> O 0%) <br /> T R COMMENTS <br /> A I <br /> N TANK MATERIAL ( TE FIBERGLASS <br /> K C , OTHER) TANK SIZE <br /> / O TANK CONDITION (GOOD, PDDR, OLES) : <br /> N ! <br /> , S PIPE MAT STEEL, F I H GLASS, OTHE R�) # FEETIk P T f, <br /> F I PIPING CONDI D POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A �� 7 sc v-PGzc�c�r / <br /> I N <br /> E K 1} <br /> L <br /> D EXCAVATION SIZE: <br /> S X X i'YDS. OF SOIL: <br /> I A DEPTH SOIL TY 'E OBSERVATI <br /> N M P i SAMPLE # <br /> S P I , <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I �PYDS OF SOIL <br /> O H DEPTH TO G. W. : <br /> N 2 FT SAMPLI'INS METHOD <br /> it <br /> G # OF HOURS SINCE DEWATERING: '+ <br /> OTHER SAMPLE: <br /> f} <br /> LABORATORY: Gt1e� ii ac�r� �sctrl,� SAMFILERS NAME: J <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> _H 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />