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5JLJfb - LJ;I L)I,kG I iUU I ii) TANK Li,(-)"'U CTI i <br /> (SHADED AREA BE FILLED IN FOR THE FIR TANK ONLY) <br /> . . . . . .... .... ... ....... ...... ..... ..... .. .. . . . <br /> Vilul-Mli'll M-1114% <br /> T)ff3a&13q- p 77,Ac <br /> G OWNER PHONE I <br /> OWNER NAME 4(72 <br /> N CONTRACTOR5CON. PHONER <br /> /le <br /> E <br /> ISJLHD PERMIT I <br /> R EPA I FIRE PERMIT 0 D-r F <br /> A <br /> 44 <br /> lit <br /> INSPECTOR DATE 6Ar I TANK 1 39 - <br /> R RINSED (YIN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHODo <br /> I / y '7C,�j AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST B < 203) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALFIBERGLASS, OTHER) TANK SIZE OO p <br /> K C CS7�Lll <br /> 1 0 TANK CONDITION (�OD POOR, HOLES) <br /> P N �N- ---e-1 <br /> I S PIPE MATERIAL UTMEL, FIBERGLASS, OTHER) tl FEET <br /> P T /,4 <br /> I PIPING CONDITION(.( OOR, HOLES) -75 /0 <br /> N -7WII <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T c t Gt <br /> F A <br /> I N <br /> E K I lu PAJ-0 <br /> L <br /> DEXCAVATION SIZE: j X YDS OF SOIL: <br /> "I ' �/r <br /> S- I <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 I I i <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> M2 <br /> 0 0 <br /> 1 OF HOURS SINCE DEWATERING: <br /> HFo 11 OTHER SAMPLE: <br /> lLABORATORY: GL I SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Fil 23 0,13(7/88) <br />