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Sj. ,,,, - UNDERGRUUND TA K Ui — gANLL ,,iIENI .,i :;C110N <br /> (SHADED AREA "O BE FILLED IN FOR THE FIM TANK ONLY) � <br /> G <br /> OWNERNAMEOWNER PHONE # <br /> E I <br /> N 1 CONTRACTOR CON. PHONE# <br /> E <br /> R i < SJLHD PERMIT # EPA N FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR DATE <br /> R RINSED (Y N METHOD RINSE AMOUNT <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%) NJn <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL qTE L, FIBERGLASS, OTHER) TANK SIZE s <br /> K C - <br /> / 0 TANK CONDITION (GOOD, POOR, 'HOLE <br /> P N <br /> I S PIPE MATERIAL (STEE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR HOLES ) <br /> N <br /> G REXCAVATION <br /> TYPE OBSERVATION SAMPLE # <br /> T z_- <br /> F A n <br /> I N <br /> E K <br /> L <br /> D IZE: 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 /> mOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> EH 23 043(7/88) <br />