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._.• 0111/A4ANDUNMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> G OWNER NAME OWNER PHONE M <br /> N CONTRACTOR CON. PHONEM <br /> R SJLHD RMIT C EPA Y <br /> A FIRE PERMIT <br /> L < <br /> INSPECTOR G DATE 3�S�j TANK { 39 - a.SSd- _ c� <br /> IRINSED (0/N) METHOD fy �* RINSE AMOUNT SS <br /> N <br /> S RINSATE DISPOSAL SITE <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (('N) METHOD oAMOUNT USED 7S(b5 <br /> A f - <br /> Ce <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, 00 HOLES) <br /> P N <br /> I S PIPE MATERIAL STEE , FIBERGLASS, OTHER) Y FEET G/u <br /> P T ' <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> � T /� SAMPLE tk <br /> F A O4 h c I Tx a N <br /> I N <br /> E K <br /> L <br /> D S- <br /> EXCAVATION SIZE: X X YDS OF SOIL : 7 <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE I) <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 /> f I <br /> 0 H DEPTH TO G.W. : FTSAMPLING METHOD <br /> N 2 �✓�4Ss tier <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> FO I OTHER SAMPLE: <br /> LABORATORY: /L1 c �G �e SAMPLERS NAME: 7�on U <br /> CL03URE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE NAP ON REVERSE <br /> s <br />