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SJLNU - UnUA�I<V. uru 'rniVn �.L V:J UII L•/u/yuv wl.r ♦L�lI�.. VI. � <br />(SHADED AREA TO' DE FILLED IN FOR THE FIRST TANK ONLY) <br />E , OWNER NAME S7ci�l�� OWNER PHONE I 9y <br />N I,` CONTRACTOR �L UK�� 0. 1 MG CON. PHONED' Q <br />E <br />R/ SJLHD PERMIT I EPA I FIRE PERMIT I, l O <br />L <br />T <br />A <br />N <br />K <br />P <br />I <br />P <br />I <br />INS <br />R <br />I <br />N <br />S <br />E <br />V <br />A <br />P <br />O <br />R <br />C <br />O <br />N <br />S <br />T <br />RINSATE DISPOSAL SITE <br />MANIFEST I -OR- OTHER <br />VAPORS PURGED (Y/N) METHOD t2R y -I F <br />L.E.L. READING AT REMOVAL (MUST BE < 201) <br />COMMENTS <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />TANK CONDITION (GOOD,POOR DOLES) <br />PIPE MATERIAL STEEL FIBERGLASS, OTHER) <br />11 <br />PIPING CONDITION (GOOD, POOR HOLES) <br />AMOUNT USED <br />TANK SIZE <br />Y FEET % ; / <br />N <br />C <br />L <br />DEPTH SOIL TYPE <br />ECTOR <br />SAMPLE U <br />DATE <br />TANK Y 39 - 12 Y-�' - <br />RINSED (Y/N) <br />METHOD <br />I <br />E <br />L <br />D <br />RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />MANIFEST I -OR- OTHER <br />VAPORS PURGED (Y/N) METHOD t2R y -I F <br />L.E.L. READING AT REMOVAL (MUST BE < 201) <br />COMMENTS <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />TANK CONDITION (GOOD,POOR DOLES) <br />PIPE MATERIAL STEEL FIBERGLASS, OTHER) <br />11 <br />PIPING CONDITION (GOOD, POOR HOLES) <br />AMOUNT USED <br />TANK SIZE <br />Y FEET % ; / <br />N <br />C <br />L <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE U <br />T <br />Z <br />I <br />E <br />L <br />D <br />N <br />K <br />, / �7 / <br />EXCAVATION SIZE: LLX21 ZL x1-2 <br />YDS OF SOIL: <br />/ <br />C/ �h <br />I <br />N <br />S- <br />A <br />M <br />P <br />DEPTH SOIL TYPE <br />OBSERVATION <br />S MPLE I <br />— atm <br />S <br />P <br />I <br />P <br />E <br />C <br />T <br />L <br />I <br />N <br />G <br />P <br />E <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />S <br />I <br />0 <br />H <br />DEPTH TO G.W.: <br />FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br />A OF HOURS SINCE <br />DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: <br />VOLUME: <br />DRAW SITE NAP ON REVERSE <br />