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SJLHD - UNGltUUND 'TANK CLU5UHh'/h1(AND 11ai'1' 11JSYLC'1'luN <br /> (SHADED AIc� TO DF, FILLPD IN FOR T11L•: •:RST TANK ONLY) <br /> t7 - <br /> 01 t 5gekr5 <br /> G OWNER NAME ` OWNER PHONE tl p"; <br /> E Io�N vtP kw ;� e//s-31,3- 0681( <br /> NE CONTRACTOR We.+r� � M CON . PHONE# <br /> Z�-,�qg-6 �y <br /> R LJ <br /> 'LHD PERMIT tl ke 4 . G a Mum' <br /> EPA qrq caz;s z FIRE PERMIT tl P ,6 IRA MIMI' <br /> INSPECTOR r � DATE 3 TANK tl 39 - 66, ir,.Lff, - <br /> R RINSED Y N) METHOD���fiLlt�rP t�/1sP RINSE AMOUNTS <br /> N RINSATE DISPOSAL SITE p <br /> S A1�t(n 7r ferVfc.vS 133-31 N NUN " <br /> E MANIFEST I -OR- OTHER _Ub5; --r,-1 d, ,n;;J.o� •,u '''P:. 0 <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USEC <br /> A U> �c1? i 2 O 1l05 <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) NonrP ' <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STEE , FIBERGLASS, OTHER) i FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) fair <br /> N <br /> C T DEPTH SOIL TYPE OBSERVATION SAMPLE q <br /> F A 1 __!3' 6 ' 1 r- (r, /r� ail 0 urx<s caro rai n <' <.� <br /> I N n^ oGi✓aas nz</u�fidN L G✓. _ <br /> E K <br /> L <br /> D S EXCAVATION SIZE: 3d X z2- X !_; YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE tl <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 C.N. : FT SAMPLING METHOD <br /> N 2 , <br /> 0 I OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: co/ SAMPLERS NAME: <br /> .. RO!✓Lr­ IUr�.i i^C <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> ARAN SITE MAP ON REVERSE <br />