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(SHADED AREA TO BE FILLED IN FOR THE FIR r: TANK ONLY) <br /> ♦ J <br /> 1 <br /> G < OWNER 'NAME OWNER PHONE I <br /> E <br /> N < CONTRACTOR CON. PHONE# <br /> E <br /> R < SJLHD PERMIT I EPA I FIRE PERMIT # <br /> L ' � ��_ <br /> INSPECTOR DATE TANK I 39 - Z 3 S/ - =— <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (YIN) METHOD AMOUNT USED 0 <br /> A _ <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL' (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR 'HOLE <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 SAMPLE I <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 1DS OF SOIL: <br /> _ X <br /> X Y <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 <br /> T G TRENCH DIMENSION d —X ,-- YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> y LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2:1 04:3(7/88) <br />