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S.1LHD -� Uh ytGfUUND TANK kE/A !NIMLN1I NSLLCY !UN <br /> LOSL <br /> (SHADED 1112L�11 TO BE FILLED IN FOR THIr FIRST TANK ONLY) ' <br /> '­vj"., Ai = - '� <br /> 641,mcgo 2- e_ y2 /l/• L!n/vn S <br /> G OWNER NAME OWNER PHONE # <br /> E llrr�in <br /> N CONTRACTOR S efiGt?7 CON. PHONER <br /> E . <br /> R i SJLH PE�tMIT Y �.�rov dobog8 . <br /> EPA Y. FIRE PERMIT 9 <br /> INSPECTOR e , DATE 7-, A,pr TANK 9 39 -- i//J1 <br /> RINSE AMOUN <br /> R RINSED CYN) METHOD lid <br /> I <br /> N RXNSATE DISPOSAL SITEIle, <br /> `i <br /> E MANIFEST a <br /> .,,. -OR-j. 0 'HER <br /> V VAPORS PURGED (Y/N) MET' OD nuf ►•ec Ps Ste'/ AMOUNT USEp <br /> A as hef d u?a�c� <br /> P L.E.L. READING AT REMOVAL '(MUST BE (° 20 ) <br /> T R COMMENTS <br /> N TAMC MATERIAL {STEED, FIBERGLASS, OTHER) TANK SIZE s <br /> K c . Odd <br /> / O TANK CONDITION ( OOD, POOR,-jHOLES) <br /> P N I ' <br /> ' I S PIPE MATERIAL S EEL FIBERGLAS , OTHER) V FEET r <br /> P T <br /> �� <br /> I PIPING CONDITION GOOD POOR, HOLES) <br /> N <br /> GDEPTH SOIL TYPE OBSERVATION . I,' <br /> T SAMPLE I , <br /> F A / �' " •sc ar`cz�r ;. . <br /> Y N ' <br /> L ,. <br /> D EXCAVATION SIZE: Is X (� X // <br /> g: .� YDS OF SOIL. <br /> iI A DEPTH SOIL TYPE OBSERVATION <br /> ' <br /> N M P SAMPLE <br /> S P I <br /> P L p <br /> C N <br /> T G TRONCH DIMENSION <br /> X <br /> I .� X YDS OF SOIL <br /> H DEPTH TO C.N. : FT SAMPLING METHOD !i <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> t LABORATORY: ` .-� /_ <br /> F c- Gl/Gr+ .; b _. SAMPLERS NAME: b <br /> CLOSURE IN PLACE MIXTURE: <br /> t VOLUME: <br /> 3'!t 23 04-V7/80 <br /> DRAW SI TF MAP ON R'EVER3T: <br />