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-• '� �t gS7I•i ul —sr— ,c'TIF'iC1�'lIOti �F U1;llEltGtt� liU t3YE3TElt <br /> ity WIC Nuntbar t L,O`t <br /> • . ' vintrictt�_ <br /> facility Address, s 7?DO IVl4Q:1 c�. t�AnRritc.R <br /> • Purpose of Visit _ �I Z �,e-a-� ��� e N �e-}-+�', cA•�-►o,� � r�.,,y� - <br /> Tank/Lille Material [ ] Steel <br /> Fiberglass <br /> Product Tanks [ ] Si11yle Wall <br /> Product Lines [ ) Sittyle Wall Double Wall <br /> -14aste Oil Tom),, [ ] Single WallUouble Wall <br /> [ ] Double Wall [ ] Notie <br /> Yr0cluCt ILI" )four torin r y-g—LO LU <br /> QTY 7.'YPL•' ' <br /> [ 3j ztiterstitial t•1oniL•or <br /> Vadose Zone tlotiitor ] Wet L ] Dry <br /> [ ) Monitored Visually ( Daily Ittvetttory) <br /> 1 nufacturer : 1,A VI ItAeslervoir <br /> [ ] API UOS (VADOSL) [ ] GReslco C ] APT IRPADOSE) <br /> •[ J OC [ ] Pollualert [ � Leakalert• <br /> [ ] Soil Sentry [ ) Iced Jacket <br /> [ ] Spearhead [ ) Other <br /> • ode ���1 �q-�--� X 7h ����C-�/ <br /> Status Q Arrival : [jq pl)eratiottal <br /> Corrective Action: C ) Lott-operational <br /> [ ] V erformed [ ) Required <br /> Status e Departure : OPeratiottal <br /> [ ] tlon-operational <br /> rocluct Liao �lonitvrittu lite w <br /> . QTY 'TYPE <br /> [,7j] Electronic Line Pressure I-1011itar w/ Mechanical Leak. Detector <br /> [ ] Interstitial moltitor w/ tlecltattical Leak Detector <br /> [ ] 2lecliattical Leak Detector Alotte <br /> L' eqLro tic ,!tie JjLgssute c�i l.)it:ersLiti� nt: <br /> l_ hioor 1.1�nuLacturers <br /> A111 S <br /> [ API Pressure [ ] ump [� API Sulu Line <br /> Leakalart. [ ] Other / <br /> o e N1J A.11�I x7b 11 Z 1 0 �i:10 1i ..•�,c^1'SD�S <br /> Status p Arrival : GL_ <br /> Corrective Action : L ] Oerfor ed [ ] !1011-operational <br /> [ ] Performed [ ] Required <br /> Q Depai"ture : [x] Operational [ ] 11011-operational <br />