Laserfiche WebLink
(SHADED AREA `'FO BE FILLED IN FOR THE FIRaf TANK ONLY) <br /> J t� VVVK IJ O •F , <br /> T <br /> G OWNER 1NAME ML- OWNER PHONE I <br /> E n / I <br /> N < CONTRACTOR 9e l W00 dJ CON. PHONEY 3 3 S/_ b 7y D <br /> R SJLHD PERMIT IEPA M FIRE PERMIT I <br /> L � � ffrm- i <br /> INSPECTO[y,, DATE /p �y fid' TANK I 39 - 3/ 3� - 2— <br /> RINSED (Y/N) METHOD RINSE AMOUNT �5 <br /> - I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD 21 �� AMOUNT USED / <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEELIB ASS, OTHER) TANK SIZE 0De�p <br /> K C �urywr <br /> / 0 TANK CONDITION (GOO P00 OLES) ✓�'�eg o45. <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH OI TYPE OBSERVATION SAMPLE I <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X ��X YDS OF SOIL: �S <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 I <br /> O [jH DEPTH TO G.W. : FT SAMPLING METHOD <br /> N I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> .1.1UHLABORATORY: SAMPLERS NAME: <br /> 1 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 1;112:i 043(7/88) <br />