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:,.�Li.✓ ,RC1 '6h'J'JA" 1'i►�.n l.LVSl�atr./eft 4[�l� :aLar'i L..:lt'L'lr'L t VC1 <br /> (SHADED A TO BE FILLED IN FOR THE F•fRST TANK ONLY) <br /> 1HP a La' rrl SkN <br /> G t OWNER NAME (CLtN 2 OWNER PHONE # <br /> Er <br /> e(r <br /> N ; CONTRACTOR CON. PHONE# <br /> R SJLHD PERMIT # A # FIRE PERMIT <br /> A <br /> L <br /> INSPECTORDATE TANK # 39 <br /> R RINSED ( N) METHOD RINSE AMOUNT3`jd <br /> I <br /> N RINSATE DISPOSAL SITE 1"1 2 <br /> S 54 -' <br /> E MANIFEST # 5 �� - R- . OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A 10 <br /> .P L.E.G. READING AT REMOVAL (MUST BE t 20%) ,,,rQ n <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA �SiEEFIBERGLASS, .OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITIO (G OD POOR, HOLES) <br /> P N <br /> I LS PIPE MATERIA (STEEL FIBERGLASS, OTHER) # FEETPIPIPING CONDITIO (G00 , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A 1 a06& xie5 . <br /> I N <br /> E K �` <br /> L <br /> D EXCAVATION- SIZE: ,L X N X Ij- 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 <br /> z ' � <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: ca( ��ar 711 SAMPLERS NAME: f <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Li[ 23 043(7/88) <br /> :; <br />