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(SHADED AR" TO BE FILLED IN FOR THE F ST TANK ONLY) <br /> 1�e R O S I t(ftlL <br /> G OWNER NAME \e Ro 'I p <br /> RT_A)� OWNER PHONE # 914a a l I <br /> E 1� <br /> N < CONTRACTORK)0k-VO CAL. CONSI . CON. PHONE# <br /> E <br /> R SJLHD PERMIT I EPA # FIRE PERMIT # <br /> L _L t <br /> INSPECTOR '� Ff�Vi�fl DATE Ip �� �� TANK # 39 - II � � - Oon <br /> R RINSED (Y METHOD � ' �- RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD 1 _C AMOUNT USED S <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEEL,iFIBERGLASS, OTHER) TANK SIZE 3 UO <br /> K C � .- <br /> / O TANK CONDITION 200D, 'POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) ^_ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A "An x1 No odor py *1 ? <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 71 X X S YDS OF SOIL : <br /> S- — <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <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 YDS OF SOIL MIK60 <br /> I e <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑0 OTHER SAMPLE: P ' ( j <br /> LABORATORY: F6, L_ SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: yJ ��% VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />