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JSUVi "q 141 L)c'' 1�2J'1' 1N:;1'LC'C1t11 <br /> IIAbIt"D A,, TO BE FILLED IN FOR THE I ST TANK ONLY) <br /> �L. 1`. . � <br /> G < OWNER NAME ;: <br /> E OWNER PHONE N <br /> N CONTRACTOR CON. PHONEq <br /> E < <br /> R SJLHD PERMIT II EPA p FIRE PERMIT 0 <br /> INSPECTOR DATE TANK d 39 <br /> R RINSED / ) METHOD RINSE AMOUNT� � <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST q ': -OR- OTHER <br /> V VAPORS PURGED �(Y N) METHOD j �, AMOUNT USED # <br /> A r_ <br /> 000 <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( 31E +L, FIBERGLASS, U`['}IEtt) H <br /> SI'LE <br /> K C = OOD <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I LS PIPE MATERIAL (STEEh� FIBERGLASS, OTHER) # FEETP <br /> I PIPING CONDITION (G00 , POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE f� <br /> IN <br /> E K <br /> L <br /> D S- EXCAVATION SIZE: X X YDS OF SOIL: <br /> -----------_ <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE f� <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 <br /> I YDS OF SOIL <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 11 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE:j ,� <br /> LABORATORY: t� ��� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 011(7/88) DRAW SITE MAP ON REVERSE. <br /> ILII '?'I <br />