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- q <br /> JJLHU - uu Ubl<coulru IdmA Uaul%'/ ,y,. .......... <br /> (SHADED AREA TO DE FILLED IN FOR THE FIRST TANK ON-,,Y) <br /> G + OWNER NAHE O Al i OWNER PHONE Y : <br /> E <br /> N CONTRACTOR Cy215 CON. PHONEI ' <br /> E <br /> R SJLHD PERMIT 1 EPA M FIRE PERMIT 1 i 1 <br /> L � � : <br /> INSPECTOR �. �, v C=, - DATE _ ' TANK 1 39 <br /> R RINSED (Y/ ) METHOD - RINSE AMOUNT <br /> I J r, y <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST M -OR- OTHER <br /> V VAPORS PURGED { N) METHOD y AMOUNT USE��� <br /> .A �I; 1�' <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL CSTEELf FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD;, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) 1 FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N �1?e <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> F <br /> I N <br /> E K <br /> L <br /> D 3- EXCAVATION SIZE: X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N H P SAMPLE @ <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 /> N 2 — <br /> O H DEPTH TO C.H. : FT SAMPLING METHOD <br /> 0 1. 1 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> l:ff 9'1 04'1(7/RR1 DRAW SITE NAP ON REVERSE <br />