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(SHADED Al TO DE FILLED IN FOR THE V RST TANK ONLY) <br /> UP% gal <br /> G OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR ������� DATE TANK # 39 - <br /> R RINSED (Y/W) METHOD RINSE AMOUNT <br /> I <br /> N <br /> / <br /> RINSATE DISPOSAL SITE `'� .�0�� <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED .(Y/N) METHOD �,J� AMOUNT USED ,'SiG ��do <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N 1' :[1r. li'fSRIAL, i'Eet., r'IBERGLASS, OTi.nu , : L '!L 7000 <br /> K C 1 <br /> / 0 TANK CONDITION (GOOD, OOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL QSTE4, FIBERGLASS, OTHER) u1Lt <br /> P T C� �+G L`e V <br /> I PIPING CONDITION (GOOD,�POO , HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A c ✓ i s -f'e-�- _ <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> S- — <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P IG <br /> P L P <br /> ' <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. : 1r FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> UHF-o] OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />