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...-..,..� �.ei.:.. 1J1{..1+.�.. •t"vp' �:�..VjUtily/AlaANIJUNI'►ilv't ,ILVJYk:C:'1'AUN <br /> (SHADED ART,'~,TO BE FILLED IN FOR THE F---.5T TANK ONLY) <br /> G OWNER NAME OWNER PHONE I <br /> E <br /> N < CONTRACTOR , .ICON. PHONE# <br /> E <br /> R i SJLHD PERMIT I EPA �11 FIRE PERMIT V <br /> INSPECTORATE 01c fes; TANK # 39 - -- <br /> R RINSED / V) METHODTTrRINSE AMOUNT�M . <br /> - I , <br /> N RINSATE DISPOSAL SITE <br /> S p <br /> E MANIFEST I MZ0901 ! -OR- OTHER <br /> r - V VAPORS PURGED N) METHOD �r r AMOUNT USED �� <br /> A Y , <br /> .P L.E.L. READING AT REMOVALHMUST BE C 20%) --- <br /> O <br /> T . R COMMENTS <br /> A - I <br /> N TANK MATERIAL (STE L, IBERGL , OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD POOR, HOLES) nv �Ic4s_!> <br /> P N <br /> I JS PIPE MATERIAL (STEEL, FI RGLAS , OTHER) v FEET <br /> P <br /> I PIPING CONDITION 00 , POOR; HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A _ no cu fi d <br /> I N l o,-, r(.t t'j 2.rPtE 5' <br /> - <br /> L 1 <br /> D EXCAVATION SIZE: X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P <br /> S P I <br /> P L P S� �-� o O' L O S-t( <br /> E I E <br /> C N F <br /> T G TRENCH DIMENSION 2X 2 X YDS OF SOIL <br /> z E° <br /> 0 H DEPTH TO G.W. : -" FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: r <br /> y 4 <br /> OTHER SAMPLE: `- <br /> i <br /> LABORATORY: L SAMPLERS NAME: 6ULLI f-.5 '-- <br /> CLOSURE IN PLACE MIXTURE: R VOLUME: <br /> DRAW SITE ';MAP ON REVERSE <br /> Ell 23 043(7/88) <br />