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k <br /> Q, SJLHU = UNV ` OUNU TANK (;LbsUR): ALS11ND�r"' 4-1- iNaIlLC`1'.Ui� <br /> (SHADED Alk TO BE FILLED IN FOR T ,E (ST TANK ONLY) <br />'. G OWNER NAME � �G OWNER# PHONE # �� <br /> E ,# gas IV t <br /> N c CONTRACTOR��� Ec? CON. PHONES <br /> E <br /> ij I6 �f7 <br /> R t SJLHD PERMIT tl !WiI0�i 3q� FIRE PERMIT <br /> L <br /> INSPECTOR DATE ��' TANK 0 39 — <br /> R RINSED Y N) METHOD I 1iF RINSE AMOUNT/02 <br /> N RINSATE DISPOSAL SITE i <br /> i S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED Y/ ) METHOD O � �:C� AMOUNT USED M <br /> A j a� <br /> i P L.E.L. READING AT REMOVAL (MUST BE C 2©%) <br /> 0i 1r i <br /> T R COMMENTS + <br /> A r <br /> i N TANK MATERIAL STEEL FIBER GLASS, i3OTHEEZ) TANK SIZE <br /> K C <br /> / 0 TANK CONDITIO (GOOD POOR,;; HOLES)" <br /> P N �; i <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) FEET <br /> P T L <br /> I PIPING CQNDITIQ (GOOD, POOR, HOLES } g�r <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION j �� SAMPLE # <br /> T <br /> F A I <br /> I N c: O <br /> i <br /> iE K <br /> L t <br /> D EXCAVATION SIZE: X, 2-';77 X '1 1 f YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P 11 I <br /> S P I <br /> P L P �l I <br /> E' E I E ' <br /> C N <br /> } <br />` T G TRENCH DIMENSION XI X11 k YDS OF SOIL <br /> I ' <br /> ' 0 H DEPTH TO G.W. : FT SAMPLING ETHRD 5 �� <br /> N 2 w <br /> E � <br /> 0 1 OF HOURS SINCE DEWATERING: 0 <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: UdP <br /> v <br /> s CLOSURE IN PLACE MIXTURE: VOLUME: N �{ 1 <br /> DRAW SITE MAP ON REVERSE � <br /> Elf 2:3 0,1:3(7/88) l'p <br />