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SO# /063, O4' 5wdd/,- C,'� Cti cv site# <br /> MONITOR WELLS ' <br /> Well Numberl 1 1 2 3 4 5 1 6 7 8 9 10 11 1 12 <br /> Well De th <br /> Depth to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: OFill OV Vapor Recovery <br /> /B V.R. w / Ball Float OM Monitor Well Op Observation Well <br /> (Outside Tank Bed Area) (Inside Tank Bed Area) <br /> © Ball Float GO Tank Gauge O Vent <br /> ❑M Manway EI Iron Cross ❑T Turbine <br /> Location Diagram?Include the Vapor Recovery System. <br /> Pw�do l <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . ❑ . . . . . . <br /> . . . . . . . . . . . . . ❑ <br /> . . . . . . . . . . . . . . . . . . . .❑. . . . . . . H <br /> yEl . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . r <br /> �l . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> 1;aG� <br /> E71 r . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Vapor Recovery System & Vents were tested with which tank? <br /> Parts and Labor used <br /> General Comments � ; L S <br /> L v�.4, •v � _ � �w <br /> When OWNER or local regulations require immediate reports of system failure-Complete the following: <br /> REPORTED NAME I DATE TIME <br /> TO:Ii <br /> Phone# OWNER or Regulatory Agency FILE NUMBER <br /> Print Certified Testers Name Vacutect''"Certification Number <br /> Az- G/ <br /> Certified Teiters Signature Date Testing Completed <br /> Fane-T&nkWLh**4 D1 <br />