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5JLHU - ulruGH wHu <br /> (SHADED AREA TO D FIRST <br /> ON • ) <br /> E1FIL-fLCED IN FOR THE FIRST TANK ONLY) <br /> EOWNER NAME 7�2AN/5 ! 9ss76 #� <br /> ' OWNER <br /> E ` CONTRACTOR���� N�S � CON. PHONE# . �c <br /> R l SJLHD PERMIT 1 P IAo' 7 <br /> A c • . ; r FIRE PERMIT I <br /> L � _ . . . . . . . . . � : <br /> INSPECTOR DATE TANK 1 39 <br /> R RINSED (Y/ METHOD ed VL- z' RINSE AMOUNT Q <br /> M <br /> N RINSATE DISPOSAL SITE <br /> S o /G�SUr <br /> E MANIFEST 1 -OR- OTHER <br /> VVAPORS PURGED (9/N) METH <br /> ODPR) C4�5_ <br /> AMOUNT USED �S <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> (1n1, usallh� <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K <br /> c /OD D <br /> / 0 TANK CONDITION GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) I FEET <br /> P T <br /> I <br /> PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T IS MPLE 9 <br /> F A LL l b �G L ✓ <br /> I N n E <br /> E K <br /> L <br /> D EXCAVATION SIZE: LS_ X Lt_2 X / YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE 1 <br /> S P I <br /> P L p <br /> E I E <br /> c N <br /> T G TRENCH DIMENSION <br /> I X _ X YDS OF SOIL <br /> 0 H DEPTH TO C.N. : FT <br /> N SAMPLING METHOD <br /> 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: PGL_ SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> tal 7.:1 (lA3f7/ual DRAW SITE HAP ON REVERSE <br />