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f <br /> (SHADED AP-A TO BE FILLEDrXNVFOR THE ^TRST TANK ONLY) <br /> 1 li <br /> G OWNER NAME OWNER PHONE V <br /> E <br />� <br /> N. CONTRACTOR CON <br /> '� : PHONE <br /> R SJLHD PERMIT I EPA i FIRE PERMIT # <br /> INSPECTOR <br /> DATE :;TANK 1 39 <br /> � a <br /> METHOD <br /> RINSED Y H) G✓ <br /> i:. RINSE AMOUNT <br /> S �� <br /> ' N , RINSATE DISPOSAL SITE <br /> 41. 4S <br /> E MANIFEST <br /> . . .,. - —OR— OTHER <br /> V VAPORS PURGED /N) METHOD <br /> A �'O Z �ti. AMOUNT USED/S Loi, <br /> .. P . L.EL. READING AT REMOVAL (MUST BE C 20$) <br /> O <br /> :T R COMMENTS <br /> N TANK MATERIAL5TE� . <br /> ' K C FIBERGLASS,: OTHER) TAMC SIZE <br /> i dod <br /> / O TANK CONDITION (GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL,•(STEEL, FIBERGLASS,I' OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR HOLES) <br /> I N <br /> G DEPTH SOIL TYPE `OBSERVATION <br /> T SAMPLE <br /> y ; <br /> '. I N l o <br /> E K <br /> L <br /> D EXCAVATION SIZE: <br /> S- <br /> X X; YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N. M p SAMPLE II <br /> S P I ad <br /> 77 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION`X !' X ' YDS OF SOIL <br /> I <br />` O H DEPTH TO G.W. : FT ' SAMPLING METHOD <br /> N 2 <br /> ,O # OF HOURS SINCE DEWATERING: <br /> i <br /> I[EFOTHER SAMPLE: <br />! LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> �_L_ <br /> DRAW SITE MAP ON REVER <br />