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(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) { <br /> s, 3 Ur L 3 *. <br /> G OWNER NAME OWNER PHONE I <br /> E GA <br /> N < A �n CON. PHONEI 3� 9Q <br /> CONTRACTOR,/-/ <br /> R < SJLHD PERMIT I EPA I <br /> FIRE PERMIT I <br /> I NSPECTOR,�V DATE / TANK I 39 - 7 ,51 - L- <br /> R RINSED (Y/N) <br /> METHOD E AMOUNT <br /> - I <br /> N RINSATE DISPOSAL SITE <br /> S -OR- OTHER <br /> E MANIFEST I <br /> V <br /> VAPORS PURGED (Y/N) <br /> METHOD Z AMOUNT USE <br /> c OFA <br /> p L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> O <br /> T R COMMENTS j <br /> AC)C) E <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER) TANK SI E <br /> K C lffy CoR eOSior✓ <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) "des eXN <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEE <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> NSAMPLE I <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T G <br /> F A <br /> I N <br /> E K <br /> LSOIL: <br /> S <br /> D EXCAVATION SIZE: X �d FX YDS OF U <br /> S- SAMPLE I <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N X X yDS OF SOIL <br /> T G TRENCH DIMENSION <br /> I FT SAMPLING METHOD <br /> O H DEPTH TO G.W. : <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: 4 AWO n//�i SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: <br /> VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2:3 0-13(7/88) <br />