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SJLHU - UHUra(G�IVU 1111vA VLVJVItL'/niyuruvrnc• .....� ..... . w. 1� 2v � � <br /> (SHADED AREA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br /> SH <br /> I'M <br /> lull' 11 Tz' IN <br /> ' 1 , . _rJ��KSrt��r .•kn���t�t� oNl�T-1����zS <br /> G OWNER NAME L OWNER PHONE 1 G y <br /> E �� ,z 2S7�FyZN TFC R A l — <br /> N < CONTRACTOR Sr C) CON. PHONEI ' �_S�/%_ G� <br /> R < SJ HD PERMIT M FIRE PERMIT 1 <br /> L ( � • <br /> INSPECTOR o ' DATE I/V TANK M 39 - <br /> 6 <br /> INR RINSED (YIN) METHOD SFE '�Of4eli Y RINSE AMOUNT foo <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST M -OR- OTHER <br /> V VAPORS PURGED (YIN) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 203) <br /> 0 <br /> R COMMENTS <br /> TANK MATERIAL ( STEEL FIBERGLASS, OTHER) TANK SIZE �AL <br /> / 0 TANK CONDITIONCOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL ( STEEL, FI9FyNGLASS, OTHER) 1 FEET <br /> P T i, <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) ' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: ,S5X 'X YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <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 /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: c"' x> SAMPLERS NAME:J', <br /> i <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE NAP ON REVERSE <br /> 111 23 04:1(7/88) <br />