Laserfiche WebLink
' .- 9� g$'�y�'ryi�7��Yy7[+7D •��'1''�4 an c�rr'�e�ao ra k'r -. <br /> G OWNER 'NAME OWNER PHONE # <br /> E a <br /> N CONTRACTOR CON. PHONE#;" <br /> E f <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR �'f�YIL DATE-tiV �� TANK #, X39 47 <br /> a - Cx�o3 j <br /> R RINSED ( ) METHOD RINSE AMOUNT <br /> 4' I . <br /> N RINSATE DISPOSAL SITE , <br /> S { <br /> #' -OR OTHER <br /> -� <br /> ` MANIFEST <br /> L!j { E <br /> V VAPORS <br /> 'PURGED . i�Yr/N} METHOD L)y AMOUNT USED <br /> A <br /> L.E. .READING AT REMOVAL (MUST BE < 20%) <br /> P <br /> E. 0 <br /> T R C&MENTS , <br /> A" , r <br /> N TANK MATERIAL(( TEES FIBERGLASS, OTHER) TANK .SIZE <br /> K C <br /> 0 TANK,CONDITIONGOOD POOR, HOLES) :'- <br /> • <br /> P N. I <br /> I S Pi'PE MATERIAL EL FIBERGLAS�, OHER) # FEET <br /> 1 <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) OA <br /> NSAMPLE # <br /> G DEPTH SOIL TYPE ` OBSERVATION <br /> T ( � F <br /> F A v Sc " } <br /> I N 3 ov, <br /> K I <br /> 11 L f a � / / , <br /> D . EXCAVATION SIZE: X as X YDS OF SOIL: r. �S _S <br /> S- ✓ SAMPLE # <br /> I A DEPTH SOIL TYPE OBSERVATION � # <br /> N M P ,. <br /> S P I t <br /> t <br /> P L P <br /> E I E <br /> C N � <br /> T G =TRENCHIMENSION X X YDS OF SOIL <br /> r <br /> I <br /> O H DEPTH TO G:W. : FTSAMPLING METHOb- <br /> �. N 2 <br /> 0 # OF HOURS SINGE DEWATERING: <br /> Fol <br /> OTHER SAMPLE: <br /> LFLABORATORY: SAMPLERS NAME <br /> CLOSURE IN PLACE . MIXTURE: VOLUME: „ <br /> i <br /> i _ <br /> . DRAW -SITE MAP ON REVERSE <br />