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• SJL: - L, TANK U,.;;SURE/AhAwi;, NMENi IN6PECIIJUN <br /> (SHADED AR BE FILLED IN R THE FA&M TANK ONLY) <br /> � <br /> G < OWNER NAME P/1 OWNER PHONE ��) 3� 7, �� < <br /> E `C .S <br /> N CONTRACTORy CON. PHONE# _ �j(S j <br /> E <br /> R < SJLHD PERMIT # jV EPA # Cti f FIRE PERMIT # N. <br /> A <br /> L <br /> INSPECTOR 4W,,4A DATE 6 ,* I TANK # 39 <br /> R RINSED ( N) METHOD RINSE AMOUN3�,4 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # .Ii/,/ -OR- OTHER Lptl� <br /> V VAPORS PURGED (Y ) METHOD AMOUNT USED �r <br /> A L <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 /> Y6 <br /> K C <br /> / O TANK CONDITION (GOOD, P00 , HOLES) <br /> P N � <br /> I S PIPE MATERIAL (/STEEL✓, FIBERGLASS, OTHER) # FEET j <br /> P T //- <br /> I PIPING CONDITION (GOOD POOR, HOLES) OCA <br /> N -- <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A IVIA j&4 Af PZ 1711) c- <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S- <br /> I A DEPTH 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 /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: _ SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> EH 23 043(7/88) <br />