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PNS-EHD - UNDERUND TANK CLO <br /> (SHADED AREA TO RE FILLED INS <br /> FOR/THE NFIRSTNTANIN <br /> KSONLY) ON <br /> E OWNER NAME <br /> �7�„„� a OWNER PHONE # ' <br /> N CONTRACTOR_ S 7"* <br /> Erre a CON. PHONE# <br /> R SJLHb ERMIT # -sem <br /> A . EPA #n �7y �9 FIRE PERMIT # C <br /> 1 <br /> INSPECTOR r <br /> C?v DATE TANK # 39 <br /> R RINSED �►N) <br /> I METHOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST # <br /> -DR- OTHER <br /> V VAPORS PURGED - <br /> q METHOD AMOUNT USED <br /> P <br /> 0 L. E, L• READING AT REMOVAL (MUST <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEL FIBERGLASS, R) T OTHER) <br /> K C TANK SIZE <br /> / 0 TANK CONDITIONlUCa9O <br /> N OD, ODRy HOLES) <br /> ' S PIPE MATERIAL (STYE <br /> P T FIBERGLASS, OTHER) # FEET <br /> I PIPINS CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE <br /> T OBSERVATION ) <br /> F A / SAMPLE # <br /> �- <br /> I N sc,.�, � i��„. 2v� /u�epll ' <br /> ia” fro <br /> E K <br /> r �� ti <br /> L <br /> D EXCAVATION SIZE! <br /> X X ..L_ YDS OF SOI L <br /> I A DEPTH SOIL TYPE - <br /> N M p OBSERVATION <br /> S P I SAMPLE # � <br /> p L p <br /> E I E <br />' C N <br /> T G TRENCH DIMENSION <br /> I — X X YDS OF SOIL <br /> O H DEPTH TO G, W, ; <br /> N 2 ...... <br /> ......... <br /> FT SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING! ' <br /> 0 OTHER SAMPLE.t <br /> LABORATORYt n <br /> SAMPLERS .NAME <br /> CLOSURE IN PLACE MIXTUREt �Ua <br /> f .230k3 ( 10/A9) � - - VOLUME: <br /> DRAW SITE MAP ON RFu�pc� <br />