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SJLHU - URULjCGRuUI+v DANK 1t:., ZCTI -).� <br /> (SHADED AREA BE FILLED I:N_ FOR THE Flf TANK ONLY) <br /> � �e . . a <br /> JE OWNER NAME / OWNER PHONE Y <br /> CONTRACTOR r�� <br /> /� CON. PHONE M <br /> SJLHD PERMIT I EPA 1 FIRE PERMIT 0 <br /> L — <br /> I NSPECTO� DATE /1 6 ti si" TANK 0 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) METHOJ ) ��� AMOUNT USED S <br /> A // <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITI GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL EE , FIBERGLASS, OTHER) Y FEET �U / <br /> P T <br /> NPIPING CONDITION (GOOD, OOR, HOLES ) --7a ReuSe p, / /�BIJ <br /> G DEPTH SOIL TYPE OBSERVATION SA PLE I <br /> T <br /> F A ,y I �n <br /> I N 3 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 21 X Z� YDS OF SOIL: .16 <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE M <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 METHOD <br /> j N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> H F-o-11 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2:1 04,(7/88) <br />