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Work Order: 2243450 <br /> l •QUALnrTESTINGOFUVDF.RGROIIND'rANJMATAFFOADABLER.4= <br /> 416 2iLd Sheet GaI4 G1 95632 ('209) 744-0112 FifX 744-0116 <br /> ' Gf°omml)IPftlg7rttlllOn Q�(.E AME.No- <br /> Facility Natfte: .Sd�� <br /> Siw Addr : 1a6,4t� IaF aatD6rc aty: I hTNfinP zip:—� <br /> Feciliry Concoct Person: <br /> ( $ Contact Phone No.: <br /> MakeJMode[of Monitoring Systtmd b�k$ QOo7 �i_S- 3Y Date of Trs[tng/Servieiog: -fj-Llf Gd <br /> B. Ihve tory of Equipment Tested/Cerh(iOd <br /> 1T,ak>h. Ie Laevbtidirate c ' menu <br /> FEJ�nic <br /> YAR Gc7 Tank lD <br /> t C»uging Probe. Mold: O N-Tank Caugin g Probe. MOM: <br /> SpaCC w Valt Samar. Model: ❑ Annular..VjTm hSSom(s Model:Some I Trench Sramt(a). Model: D PipingSump/TrenchSmsor(s). Model:tW Smeaor(a} Model: O Fill Sump SM.-W. Model: <br /> lino laxk Detector. Model: 1�� ❑ Mechanical Linc l<dt Datcctm. Model: <br /> Lane I I-k Detedw. Model: O ®amaenc Uncleak Dcb=co. ModcL <br /> ❑Tank OvufiLL/FiLh-1<vd S"— Moder: ❑ TrI overfill l High-ftvd Sa or. Model: <br /> 0 Otho( ci i and modal is Section flon P 2). ❑ oaten(a ui ad model fa Snelfm 6 sea Pa 2). <br /> T ( c e_ Tank <br /> M. <br /> k Ca=ging Pmhc. Modal• 0 IwTak G Zi.g Probe. Model <br /> lar Spats w V alt Sensor. Model: 0 Aadar Spare w Vault Senior. MadeF. <br /> Piping StuaP 1 Ttmch$euw(a). Model: 0 Piplag Suva I Tmrb Srnao>(s). Mudd: <br /> ❑ Sump Scobw(s} Model: ❑ FRI Sump Sea am(l). Model: <br /> Medtudcd line Luk Dreamt. Model:STP-M b _ 0 Muy+noicd Um Irak Dctamr. ModeF. <br /> 0 Slerstntdc Line lank DemcaN- Mudd: 0®ecUoaic tinct®k➢r tw. Model: <br /> O Tank C m E11 l High-Level Sotanr. Model: ❑Tank overfill f ITigt-Lend Smear. Model: <br /> ❑od,e, t typeend rrodd in Seed—EonP e2). OOther( eo [ andmodelin Sectim8a <br /> 21, <br /> DhpenaerlD: Dbp�@ <br /> O Diepensea Contaitmret SeuCot(s). me&,: ❑ Dispr Cautniomr Scasar(s). Model: <br /> Vdve(c]. 0 Sherr Valve(e). <br /> Cmtaimrat Plom(a)aro(2tdn(0- ❑Di Coomitm ent Rone(s)and C.bxm(r). <br /> Dlspaeser ID: ty DlepaeerID <br /> 0 "spencer Conuipnrnt5aem(c} Modei: - O DupcnwrCmttaiatrndSenwr(,). Model-. <br /> V'dw.). Ll Sh=Vdvc(4). <br /> u Cmtninmeat 1%el(c)and OLIWel. ❑ ea Convninmut Moer(s)ad Chain(e). <br /> Dispwer ID: Diym•a ID: <br /> ❑DispenwConnitmmtSaror(s} Model• 0 D'—V4 c(3I of Senam(s). Model: <br /> ❑Shur Vehre(e). O Shear Vdve(s} <br /> ❑Die tr Conednmrnt Ploet(e)and L3ain(a). ❑ ser Consateek a d dispe and n,,;.la} <br /> vlf the(acuity emaaim mote tarda w diapensm.COPY rhos Enron. Include iofanmadw for cvay took addispenses Mthe fam3ity- <br /> C. Certification-I—tLfy that the WWW nkan m aecotaanca with the nna®facbIme-' <br /> rdarman in thio d M'b d was' rh"etadts)em d� to MVY that this 1No—Lfi n is <br /> gdddiwa Attached to this j the ja 000 f oador�tlon fag-aoAmaFor—ys' rbeckld c p blt of menti'ag mch Notts,I have also <br /> meed sed•riot Plan epowheg the laYam of mooltaninE cleat net- ))y/r;{�1(�Am)e9�rrn history report <br /> arLched a copy of the report;(ckrrk stn thm alrPfl): 5Y YE <br /> Technician Name(pont): <br /> Lic use. <br /> Cutificarion Na: �77 L � Ck�_}G� <br /> Maeltaciyg System Certlndation <br /> Tanknology-NDE 8900 Shoal Creek,Building 200 Austin,Texas 78757 <br />