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• li�L.l� 2&J� :��l�w.�'-��FiS�Y.l��2�0 `✓ <br /> • � 4Y U'NDRR4R0�'n,�Yp ]{XSTE1[ <br /> Facility WIC Number : 7SZf/ /OL <br /> — District: <br /> Facility Address : <br /> Purpose of Vi'sir_ � <br /> Tank/Line Material ( eel [ ] Fiberglass <br /> Product Tanks [1--3Single wall [ ] Doulals Wall <br /> Product Lines [ ] Single wall <br /> Waste Oil Tank [ ] single Wall [ ] Double wall <br /> [ J Double Wail None <br /> 1'rodna . zat lipaitvrina gy g <br /> QTY TYP$ <br /> C ) Interstitial monitor. ( ) Wet [ ] Dry <br /> [ ] YA40ae Zone Monitor <br /> [ onitored Visually (Daily jnyantorv) <br /> Manuf � fil pr; [ ] APT RQaprvoir [ ] API IR(VADOSE? <br /> [ 7 API MOS (VDO <br /> ASE) [ ) Genelco ] L4akalert � g <br /> [ 7 OG ( ] PollualartC <br /> ( ] Soil Sentry ( ] spearhead C J Red jacket <br /> [ ) Other--, <br /> Status @Arrival ; j ] Operational. (yV1n^�':iv1' il fLHEALIli <br /> Corrective Action: [ ] Non-operate. ,11T/Su"v:- <br /> [. 7 Performed j ) Required <br /> Status @ Departure: [ ] operational [ ] Non -operational <br /> Produck ],ina M2IEit2XJAQ XyAid m <br /> QTY TYPE <br /> ( ] Electronic Line Preaeurat Monitor .w/ Mechanical Leak Detector <br /> ( ] erstitial Monitor w/ vacilanical Leak Detector <br /> [ Mechanical Leak Detector Alone <br /> $1QC .;5� J.t 1Lz Preaeuzr ;r,Se Rt '7 Pionitor Manyf urea: <br /> ( J API Pressure C ] API Sump [ ] API sump/.Line <br /> [ ] Loaka_ert [ ] Other _ <br /> Model: <br /> Status @ Arrival: [ ] Operational _ [ ] Non-operational <br /> Corrective Action: [ ] Performed [ 7 Required <br /> Status @ Departure; [ ] operational [ ] Nan-operational <br /> CONITNUED ON REVERSE <br />