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UN*CuuunU TANK <br />(SHADED AREA TO <br />BE FILLED LINUFORAD <br />THE FIRST TANK ONLY) <br />uANL•'N'1' 1NSPEC'1'l UN <br />�I GOWNER NAME kiZ�it <br />E � <br />N OWNER PHONE Y <br />1` CONTRACTOR <br />E <br />R CON. PHONEY <br />` SJLHD PERMIT Y: <br />LF�itti I1......... EPA Y <br />i2�'t'�d'�y�� d '. .• `I�iFI+'TRE+ PERMIT�jY'�'� <br />INSPECTOR 6 CL` 1'I.COftSU(tl;tt21t <br />TANK Y <br />R RINSED 39 -� <br />I (YIN) METHOD �— <br />N RINSATE DISPOSAL SITE 1 ' RINSE AMOUNT <br />E MANIFEST Y <br />V VAPORS PURGED -OR OTHER <br />A (YIN) METHOD <br />AMOUNT USED <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />A <br />N SANK MATE <br />K C QIAL t L, F1BERGLA&S, <br />0 TANK CONDITION OTMEF1' `1'Aa.K $LZE D rSEz <br />P N GOOD POOR <br />HOLES) <br />\ I S PIPE MATERIAL <br />J P T ( TEEL, FIBERGLASS, OTHER) Y FEET <br />I PIPING CONDITIO <br />N H00" POOR, HOLES) GCUuC�(y <br />G T DEPTH SOIL TYPE <br />OBSERVATION <br />F A ' U LoSAMPLE Y <br />I N _ L'�, A ��. ✓ <br />E K 0 ✓ T ` <br />L <br />D EXCAVATION SIZE: ?'X <br />S- X YDS OF SOIL: <br />I A DEPTH SOIL TYPE <br />N M p OBSERVATION <br />S P I SAMPLE Y <br />P L P <br />E I E <br />C N <br />T G TREN11 CH DIMENSION <br />YDS OF SOIL <br />0 H DEPTH TO <br />W. <br />N SAMPLING METHOD <br />2 FT <br />0n ` <br />Y OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: <br />7Y-2— SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />---_ VOLUME: <br />);II <br />DRAW S <br />2;I Oq;1(7�R8) ITE MAP ON REVERSE <br />