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_ __ .Ji\.+.i 1\� .. VL.V�V.I L'� ta T-\\lJ l�l ..L.♦V1 1..JYJiVl1 V1V <br /> (SHADED AF& TO BE FILLED IN FOR THE 'ST TANK ONLY) <br /> ?fir, . . u� I � ss <br /> a{ t <br /> G OWNER NAME Oo,- oQOWNER PHONE <br /> E <br /> N CONTRACTOR ��� �Lc C�� CON. PHONE# <br /> E <br /> l <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # 1 2 C <br /> A � � l <br /> L — <br /> INSPECTOR C w p j �- DATE ( 1 1 6 I d TANK # 39 - t> > - <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL. ( STEEL, 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) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) oO holey- ilc, f< <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I � ob cv c i <br /> P L P no C'clo� L <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X SID YDS OF SOIL <br /> I — <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: ��C ✓ �an SAMPLERS NAME: -)eFf <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />