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SO# O- Site# <br /> MONITOR WELLS i(Je� �ns{alla�;on t �/w t�••ks •�;f�,J�- Anyce- <br /> Well Number 1 2 3 4 5 6 7 8 10 11 12 <br /> Well Depth <br /> Depth to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: Vapor Recovery <br /> E) V.R. w / Ball Float OM Monitor Well O Observation Well <br /> (Outside Tank Bed Area) O (Inside Tank Bed Area) <br /> © Ball oat OTank Gauge Vent <br /> MMan- 6 Aay Fq ron Cross Turbine <br /> Lpqat.ic n Diagram-lnclude the.Va por Recovery System. <br /> . . . . . . ,1 . . . <br /> . . . . . . Pet, . . . . . . . . y� <br /> . . . . . . . . . . . . . . . . . <br /> . a�z <br /> . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . (` <br /> 000 Ir5 <br /> �J O . . . <br /> P�vS ,C'vN <br /> . .x <br /> . C11 .r <br /> 0 r •� <br /> (01 <br /> . . . . . . . . . . l . <br /> . . . . . . . . . . . . . . . . . . .. <br /> Vapor Recovery System & Vents were tested with which tank? <br /> Parts and Labor used <br /> General Comments <br /> When OWNER or local regulations require immediate reports of system failure-Complete the following: <br /> REPORTED NAME DATE TIME <br /> TO: Sc,,-)d v /6"n::�) <br /> Phone# OWNER or Re§ulatory Agency FILE NUMBER <br /> Print Certified Testers Name Vacutec Certification Number <br /> Certified Testers Signature Date Testing Completed <br /> Fore-TaNalLlr <br />