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( JHAUCU AH r.AHh, P-1LrL 14U 1N hUH 1'H h' N'1XS9'1'ANK UNLY ) <br /> rte ` � m <br /> . . <br /> t <br /> G OWNER NAME �]Vfl OWNER PHONE # <br /> E -- -- - -------------_.._. ; <br /> N CONTRACTOR �� CON . PHONE# <br /> E --- -- _.....- - -- - -' <br /> R SJLHD PERMIT # EPA # FIRE DEPT <br /> Aff �r +.ay'K.3s <br /> , PAR '� OS�JRE <br /> L -_ <br /> SJLHD INSPECTOR I TANK # 39 <br /> R RINSED (Y/N METHOD A RIE AMOUNT <br /> I — <br /> N RINSATE DISPOSAL SITE <br /> S - <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/--)- METHODCPZ �AMgT S� <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 /> K C S <br /> / 0 TANK CONDITION (GOOD, Poon HOLES) <br /> P N - <br /> I S PIPE MATERIAL��(S`T�EE�L, `FIBERGLASS, OTHER) # FEET <br /> P T \_ ----I- - <br /> I PIPING CONDITION (GOOD, OOR HOLES ) <br /> N -- <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T - -- <br /> F A <br /> IN -._..._......_..._.. - -- ......_._........---- ---- ---- -- <br /> E K - -- <br /> D EXCAVATION SIZE: I YDS OF SOIL : --J <br /> S �- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P -__....__.._..---............_................. <br /> --...... --- <br /> S P I --- ---- - <br /> P L P ......-......_._._................................ <br /> __._... --- <br /> E I E - - - <br /> C N --- <br /> T G TRENCH DIMENSIONS : 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 /> CLOSURE IN PLACE MIXTURE : VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />