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SO# /3190 Owner: <br />Site# <br />MONITOR WELLS <br />Well Number <br />1 <br />2 <br />3 <br />4 <br />5 6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />Well Depth <br />IsSi <br />Depth to Water <br />0 <br />Product Detected <br />AMOUNT in inches <br />Standard Symbols for diagram below: ( Fill <br />/B V.R. w / Ball Float OM Monitor Well <br />(Outside Tank Bed Area) <br />© Ball Float 0 Tank Gauge <br />M❑ Manway 0 Iron Cross <br />OV Vapor Recovery <br />Op Observation Well <br />(Inside Tank Bed Area) <br />O Vent <br />TD Turbine <br />Location Diagram -Include the.Vapor Recovery System. <br />L: El LJ <br />. . <br />. <br />. 00 OC9 . <br />. <br />OO 00 <br />® <br />. . . . . . . . . . . . . . . . . UW . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . '�4,vlc . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . U.C:, �s . . <br />ocb <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Vapor Recovery System & Vents were tested with which tank? <br />Parts and Labor used <br />General Comments 77777 w -eM. d <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />TO: <br />NAME <br />DATE <br />TIME <br />Phone# <br />OWNER or Regulatory Agency <br />FILE NUMBER <br />Print Certified Testers Name <br />aotLlr)l ' <br />VacutecVm Certification Number <br />O C ( I <br />Certified Testers Signature <br />Date Testing Completed <br />Foran-T8rACWL&W* WW <br />