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r (SHADED PQ"!A TO BE FILLED IN FOR THF --TRST TANK ONLY) <br /> 4A . <br /> G OWNER NAME <br /> OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# a <br /> E <br /> R SJ'LHD PERMIT # EPA # FIRE PERMIT # <br /> A � , <br /> L I lip <br /> INSPECTOR , DATE �f �'� TANK # ' 39 <br /> R RINSED Y N)., METHOD SL� RINSE AMOUNT o� <br /> I " <br /> N RINSATE DISPOSAL SITE '914 <br /> S <br /> E MANIFEST # —OR— OTHER . <br />' V VAPORS PURGED /N) METHOD AMOUNT USEp - <br /> } A t Co <br /> P L.E.L. READINGnAT REMOVAL (MUST BE < 20$) <br /> 0 <br /> T R COMMENTS <br /> A E <br /> tN TANK MATERIAL STEL., FIBERGLASS, OTHER) TANK SIZE <br /> e K C D0� <br /> ► / O TANK CONDITION (GOOD OR, HOLES) <br /> P N <br /> I S PIPE MATERIAL . (,STEE - , FIBERGLASS, OTHER) # FEET <br /> tP T <br /> I PIPING CONDITION - (GOOD,LOpO HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> 4F A <br /> I N 1 0 <br /> L K ;� <br /> +D 1' EXCAVATION SIZE' X X YDS OF SOIL: <br /> S_ <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> . N M P <br /> .tS P I Q <br /> �P L P. <br /> JI <br /> C N <br /> T G TRENCH DIMENSION X L�Lf X Z YDS OF SOIL <br /> iI <br /> 0 H ;'DEPTH TO G.W. ; _ <br /> N FT TSAMPLING METHOD <br /> 2 <br /> 0 a# OF HOURS SINCE DEWATERING: <br /> I,OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE; VOLUME: <br /> 'DRAW SITE MAP ON REVERSE <br />