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S.O.# all `I <br />MONITOR WELLS <br />Number <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />Depth <br />Water <br />Prod. Detected <br />NOT Det. <br />Location Diagram <br />PC, <br />C h. <br />Parts and Labor used <br />General Comments <br />When local regulations require immediate reporting of a system leak—Complete the following: <br />Reported to: <br />Name Date Time <br />Phone Number Regulatory Agency <br />File Number <br />S�ey <br />Print: C ified Testers Name <br />Certified Testers Signature <br />Vacutect(tm) Certification Number <br />Mk <br />Date Testing letcd Torm:Testnata •1/91 <br />