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(SHADED AR' TO BE FILLED IN FOR THE I.ST TANK ONLY) <br />DRAW SEll 23 0113(7/88) ITE MAP ON REVERSE <br />02 <br />yg <br />S <br />G <br />OWNER N ME <br />OWNER PHONE # <br />E <br />N <br />< CONTRACTOR <br />CON. PHONE# <br />E <br />R <br />SJLH PERMIT #EPA # FIRE PERMIT <br />A¢�. <br />L <br />. <br />- L- <br />INSPECTOR <br />DATE �2� �� <br />TANK q 39 - - <br />R <br />I <br />RINSED (YEN) <br />METHO /t.Gtr� <br />RINSE A OUNT, <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST # -OR- OTHER <br />VAPORS PURGED N) <br />METHOD <br />AMOUNT USED�-L/QO <br />L.E.L. READING AT REMOVAL (MUST4E < 208) <br />1%Z a -ay �.T <br />TR <br />COMMENTS <br />A <br />N <br />TANK MATERIAL(,( S TEE, FIBERGLASS, OTHER) <br />TANK SIZE 5 GG6_ <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 />I FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH <br />SOIL TYPE OBSERVATION 9la 9/dy <br />SAMPLE # <br />T <br />F <br />A <br />S' — <br />I <br />N <br />r1'C C -•z G.-v��a <br />E <br />K <br />L <br />Ds <br />EXCAVATION SIZE:'X Y X /J <br />YDS OF SOIL: <br />- <br />I <br />_ <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <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 />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />O <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />Li <br />LABORATORY: �ern. /mac, CGl• <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />J.MIXTURE: <br />VOLUME: <br />DRAW SEll 23 0113(7/88) ITE MAP ON REVERSE <br />02 <br />