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SO# //? 2 3� OWO: OEVRbAl <br />Site# /)',) 775 <br />MONITOR WELLS <br />Well Numberl 1 2 1 3 1 4 1 5 1 6 7 8 9 10 11 <br />12 <br />Well Depthl jq2Depth <br />Depth to Water c,2_ <br />Product Detected <br />AMOUNT in inches --1 <br />1 <br />Standard Symbols for diagram below: F Fill <br />V Vapor Recovery <br />/B V.R. w / Ball Float OM Monitor Well <br />Observation Well <br />(Outside Tank Bed Area) <br />© Ball Float GO Tank Gauge <br />(Inside Tank Bed Area) <br />O Vent <br />❑M Manway El Iron Cross <br />Turbine <br />Location Diagram—Include the Vapor Recovery System. <br />............................ <br />I <br />...... ..... .......... <br />li <br />...... ..... ........... <br />.... <br />...... ..... ..... <br />...... ................ <br />...... ...... <br />C VF_KZ f <br />. .© °IL <br />E <br />V <br />b <br />1 <br />l� Z <br />FL --T Ura. 0 f� r/� .—.—, <br />.1=02 L�i��31$ <br />t',t�u <br />G <br />i <br />,p . . . . . . . . . . . . . <br />. . . . . . . . <br />. <br />Vapor Recovery System & Vents were tested with which tank? <br />I <br />. <br />Parts and Labor used <br />General Comments <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />NAME <br />DATE <br />TIME <br />TO: <br />Phone# <br />OWNER or Regulatory Agency <br />FILE NUMBER <br />Print Certified Testers Name <br />Vacutec" Certification Number <br />Certified Teste Si nate <br />Date Testing Completed <br />�% <br />