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LALUSUKG/"'tANUUNI'ILIVT IIUK <br /> (SHADED A' " TO BEJ FILLED IN FOR THE "tST TANK ONLY) <br /> G OWNER NAMEOWNER PHONE # <br /> Cerp N CONTRACTORj co CON. PHONE# <br /> E ' <br /> j EPA # :MIT # <br /> R SJLHD PERMIT # FIRE PE `�i . <br /> L — <br /> INSPECTOR C .'- DATE TANK # 39 - - 0 1 _ <br /> R RINSED ( ) METHOD � ' � t RINSE AMOUNT <br /> c <br /> - I , <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (G00 , POOR, HOLES) <br /> P N <br /> ` I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> �J P T <br /> I PIPING CONDITI (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A N <br /> c % � , ea iii ti <br /> I ) <br /> E K -�' n d crm�. i - vfioN I - <br /> L <br /> D EXCAVATION SIZE: I �)- X ;V7 X -L-1 YDS OF SOIL: <br /> 3- <br /> I A DEPTH I SOIL TYPE OBSERVATION SAMPLE # <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 <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: Cal Wch�er SAMPLERS NAME: U <br /> `L..l <br /> Li <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> E)[ 23 043(7/88) <br />