Laserfiche WebLink
(Sp.ADED AREA TO 3E ILLED IN FOR THE FIRST TAN" ONLY) <br /> .ruvarrum/aul�Lim�/umrrmiarr " ivrn .f�lfuwm�i/rirriaVum:rryrrl�.rmiriuilam� is%i :0'L'.'7.�'L'!!!//V!I!!:I/'1:(lL/!f/VI!!/!!dd•• <br /> Y I c Nrl t IOY� ZLuW. W d I s GK'S y <br /> OWNER NAME HCN t 1q(o <br /> -� oCKfDy,I OWNER P <br /> � rc <br /> N CCNTRACTOR � I CCN. P!=CNE <br /> .f <br /> R S.ILHD PERMIT f� EPA O FIRE PERMIT # �P <br /> A 7rrGrG rG� =V11 V"L. v G /GrG �G btu ILL L%G7G riG /u � 'G W r� �5/r Miv`/GrGrG fr ' '�61GiGGi✓� <br /> L, �Vl-�L � l.. uSUK� I rLnl.c IclYK7-IrtT l.:.0 uKG <br /> INSPECTOR t'u►Yl �� I DATE f�,Z�-92� I TANK 4 39 - IZEZ - <br /> R ! RINSE:) I METHOD �` 1 YIn5� I RINSE AMCUNTl15 <br /> N RINSATE DISPOSAL SITE <br /> s <br /> E MANIFEST -CR- OTHER <br /> V VAPORS PURGED Y N) I MET;CD p �� Q/ ( AMOUNT USED 5z <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 2-O%) SEL- �v QZ <br /> O <br /> T R COMMENTS �. C'pS f}�. <br /> A <br /> N TANK MATERIAL CSTEEt , FI3ZRGLASS, OTHER) I TPNK SI=E (pG�D�aQ <br /> 'A Co6!cr ev <br /> / O TANK CCNDITiCN (GOOD POOR, HOLES)No UtStbC2 hAo <br /> N i <br /> S PIPE MATERIAL (ST L, rI3E3GLASS, OTHER) I r-EET to <br /> P T <br /> I i PIPING CONDITION (C--CCD F CR, HOLES) <br /> N <br /> 8 ! DEPTH I SOIL TYPE I OSSE-RVATiCN I SAMPLE . <br /> ' 3 ISt 1 <br /> A � ) &,vn <br /> I N I I <br /> = K 1 ) <br /> LEXCAVATION sI_E: _LL/ X <br /> YDS OF SOIL: <br /> I i ' A DEPTH I SOIL TYPE OBSERVATION I SAMPLE t <br /> N M P <br /> S P I (Yl <br /> P LI ) <br /> C I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> O H DEPTH TO G. bl. : FT i SAMPLING METHOD <br /> N 0 '' 4 OF HOURS SINCE DE'rATERING: C) <br /> O 1 OTHER SAMPLE: �11 <br /> LABORATORY: � I I SAMPLERS NAME: �b4j <br /> CLCSUP.E IN PLACc I MI'f.TURE: � � I- VOLUME: <br /> :i 2:0:. ( :0/89) DRAW SiTE MAG CN REVERS. <br />