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YVldaaa Vaiwa' baa -- - . --- — --- I <br /> (SUADED ARL—TO DE FILLED IN FOR THE !": .' TANK ONLY) <br /> 2-1 <br /> G OWNER NAME s OWNER PHONE C;LOe <br /> N CONTRACTOR ,_ - CON. PHONE R a a <br /> E *• <br /> R SJLHD PERMIT A EPA I FIRE PERMIT I <br /> I N S P E C T 0 R �` 4; DATE TANK 1 d9 <br /> I <br /> .J <br /> R RINSED (Y METHOD CjlfRINSE AMOUNT <br /> I . <br /> N RINSATE DISPOSAL SITE <br /> S ! <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD , AMOUNT USED <br /> A :.i <br /> P L.E.G. READING AT REMOVAL (MUST BE < 20%) � <br /> 0 <br /> T R COMMENTS' yG:�Gfit�PGE <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK AZE <br /> K C <br /> / 0 TANK CONDITION GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 9 <br /> T <br /> F A Ll c � <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X j:EYDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD Q ,,S <br /> N 2 <br /> O I OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: ,e5164 W40. SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE HAP ON REVERSE <br /> EIf 2:I 0-17 (7/38) <br />