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SO# y ((/SU Own— Site# <br /> MONITOR WELLS <br /> Well Number 1 2 3 4 5 6 7 6 9 10 11 12 <br /> Well Depth ' <br /> Depth to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: OF Fill Vapor Recovery <br /> /B V.R. w / Ball Float OM Monitor Well O Observation Well <br /> (Outside Tank Bed Area) (Inside Tank Bed Area) <br /> © Ball Float @ Tank Gauge O Vent <br /> M❑ Manway EI Iron Cross Turbine <br /> Location Diagram—Include the.Vapor Recovery System. <br /> CAP+( A -Aug. . . . <br /> . . . . . . . . . . . . . . . . <br /> eci ri R20 G{ <br /> �r' NVQ � •�N�-►�� •t: � � �.trA�Sf�CE' . <br /> qV LP <br /> v�u vrvl Vt)L <br /> <jCU/'VL g26cf-9r �Rp. <br /> . . . . . . . . . <br /> N NLQ Go�NCP 89 LGF �� �r Fkp O/4) O <br /> Nflvr�L UPJ LI$� F pN U,¢L VA L' <br /> oil <br /> . . 9 r ',F2P w . 1. <br /> c� �� r�AG SPhcc. <br /> O <br /> . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Vapor Recovery System & Vents were tested with which tank? <br /> Parts and Labor used <br /> General Comments f�LL Ptl�zoD,; c-t L,NES-)-- Ole <br /> ^' S -}- L 'S P(F ro H,,9UG7 <br /> Rep�jgap-()VOct H-(� ccz S np <br /> A (,j 5 p 4 &cJ r yv C v v v✓t iQ C (cJ :22 L- <br /> v ti Loc Q-H o v zQ c -jfi Ll N e- <br /> When OWNER or local regulations require immediat reports of system failure-Complete the following: <br /> REPORTED NAME DATE TIME <br /> TO: <br /> Phone# OWNER or Regulatory Agency FILE NUMBER <br /> Print Certified Testers Name Vacutectm Ce dation Number <br /> tau GAJ 6�. ,q tT,�S nod 3 <br /> Certified Testers Signature Date Testing Completed <br /> L,/ - -9 - <br /> Form-TaNdLtf�rWblDt <br />