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S.iLtw - uNGERGRuuNIU TANK C:- JURE/A4ANUONMLNT INSPECTION <br /> (SHADED AWkA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 061'1 2«Trc,ll�'" icdo �c.si \;ose,v, F� Ma-n4ece�. <br /> G < OWNER NAMEgv b Oc OWNER PHONE # Va 51 I Z(o 7 <br /> E <br /> N < CONTRACTOR e , fl C 1 CON. PHONE# G �o c� 0 7 15 5 <br /> E <br /> R SJLHD PERMIT # EPA lcgcaol�,6 FIRE PERMIT # <br /> A <br /> L v _ <br /> INSPECTOR(', DATE Z TANK # 39 - 1 -A <br /> R RINSED (9N) METHODRINSE AMOUNT WS/g� �V" <br /> I <br /> N RINSATE DISPOSAL SITE Q�e�nc � '-�e,ru4Cc y <br /> S <br /> E MANIFEST # µ 1llsc -OR- OTHER <br /> V VAPORS PURGED Y/N) METHOD 1 ru C e AMOUNT USED <br /> A <br /> P L .E.L. READING AT REMOVAL (MUST BE G 20%) <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (G OD'd POOR, HOLES) nO �' bW nu I ccs — LoCc D 0' <br /> P N <br /> I S PIPE MATERIA # FE <br /> (STEE ; FIBERGLASS, OTHER) ET <br /> P T <br /> I PIPING CONDITION OOD, OOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: Z I- X � X 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 E <br /> C N <br /> T G TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> H0 OTHER SAMPLE: <br /> LABORATORY:C �txL{z — l_�.4�cy SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />