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. _ .. �....(_�-1 .. ... \+.+\.JVNG�tlLysfl✓VPL llt li\Jili lr,l J(.i l'( <br />(SHADED AR' TO BE FILLED IN FOR THE F .ST TANK ONLY) <br />Ell 23 043(7/88) DRAW SITE MAP ON REVERSE <br />spar <br />G <br />OWNER NAME <br />OWNER PHONE # <br />E <br />N <br />( CONTRACTOR <br />CON. PHONE# <br />E <br />R <br />p p <br />( SJLHD PERMIT # EPA # FIRE PERMIT # <br />A <br />L <br />INSPECTOR <br />DATE q�iyl�9 <br />TANK # 39 - ljQ- o�- <br />R <br />I <br />RINSED (Y/N_) METHOD RINSE AMOUNT <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y/N) <br />METHOD <br />AMOUNT USE <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F <br />A <br />' c cu<, o U 7 <br />I <br />N <br />o cCcr d o/<ycc.Pty <br />E <br />K <br />L <br />D <br />S- <br />EXCAVATION SIZE: -5 X v X <br />YDS OF SOIL: �S (f -3 <br />I <br />N <br />A <br />M <br />P <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />I <br />G <br />TRENCH DIMENSION X X — <br />YDS OF SOIL <br />0 <br />N <br />H <br />2 <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />0 <br /># OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: 7Nf� 7 cl 1Crli- <br />SAMPLERS NAME: GLG(. <br />v <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />Ell 23 043(7/88) DRAW SITE MAP ON REVERSE <br />