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SHADED <br /> AA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> as S76 <br /> G OWNFF NAME OWNER PHONE I <br /> E <br /> N CONTRACTOR CON. PHONE <br /> E //&iyfo eas r 17w- 9 N-12 <br /> R < S JL H D PERMIT I EPA FIRE PERMIT 0 <br /> L <br /> FA <br /> INSPECTOR J IiLoq TANK 1 39 <br /> R RINSED ( N) _TMETHOD I RINSE AMOUNT,,. <br /> I I(z o <br /> N RINSATE DISPOSAL SITE <br /> S - CeDi6souTZ <br /> E MANIFEST I fff 35 2(c,-7 -OR- OTHER <br /> V VAPORS PURGED (VN) METHOD �jPy AMOUNT USED 165 <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T Rj COMMENTS <br /> A <br /> N TANK MATERIAL (tftEEr.), FIBERGLASS, OTHER) TANK SIZE <br /> K C Uo <br /> d, <br /> 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEP SOIL TYPE OBSERVATION <br /> T DEPTH <br /> SAMPLE 9 <br /> F A /X"-V% kk Lab&21..4 V /V —I 9k thz <br /> N t <br /> 'J i4tf eidor -r 9L <br /> si45" L <br /> E K Li <br /> L I <br /> D EXCAVATION SIZE: 2 ( X IS' x ;I 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 n <br /> C N <br /> T G TRENCH DIMENSION x — X YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 9 OF HOURS SINCE DEWATERING: <br /> r07 OTHER SAMPLE: <br /> LABORATORY: CC SAMPLERS NAME:M,'(,,Z <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SrT <br /> ]-*1[ 21,013(7/88) F. HAP ON MEVERSE <br />