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r MIN 414 , t T <br /> G OWNER NAME $�p OWNER P NE # <br /> N CONTRACTOR 5,$. CON . PHONE# <br /> R SJLHD PERMIT # EPA # FIRE DEPT <br /> L r 1.t <br /> ---- ` <br /> SJLHD INSPECTORS C TANK # 39 - � _ J <br /> R RINSED (Y N METHOD RIND MOUNT <br /> I <br /> N RINSATE DISPOSAL SITE �j <br /> S _ _/ <br /> -_ __.._-----._-_..- - ----- -- -..- ------ <br /> E MANIFEST 0-24t4 =0R- OTHER <br /> V VAPORS PURGED (Y N) METHOD C U AMOUNT 1L /000 <br /> A - <br /> P L .E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 ---- -- <br /> T R COMMENTS <br /> N TANK MATERIAL (( STE , FIBERGLASS, OTHER) TANK SIZE % DOB <br /> K C <br /> / 0 TANK CONDITION G00 , POOR, HOLES ) <br /> PN -- --- ------- <br /> I S PIPE MATERIAL STE , FIBERGLASS, OTHER) # FEET .-V3 <br /> P T <br /> I PIPING CONDITION (G00 , POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> I N <br /> 2r.S_ Z <br /> E K <br /> D EXCAVATION SIZE: 41'1/O XID YDS OF SOIL : <br /> S -- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P .....-------- <br /> ... ---- --- <br /> S P I ,v '� -------- <br /> PL P -._........_.._.... .._... ..-..--- --- <br /> E I E <br /> C N -' <br /> T G TRENCH DIMENSIONS : YDS OF SOIL : <br /> I <br /> 0 H DEPTH TO G.W. : '-'30 FT -- SAMPLING METHOD <br /> N 2 -- 1 ---- - --1 <br /> 0 # OF HOURS SINCE DEWATERING: A11A <br /> 0 OTHER SAMPLE:JvA - ---_ <br /> LABORATORY: e(�Q�'t� SAMPLERS NAME : <br /> CLOSURE IN PLACE I MIXTURE: ) /U VOLUME: at//p4 <br /> DRAW SITE MAP ON REVERSE <br />