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Work Order: 2251440 <br /> _. B 5 '849 <br /> 7bp <br /> WORK ACKNOWLEDGEMENT FORM <br /> VENDOR NAME. /DATE: <br /> ADDRESS:_����E / �r�;*���J,+AUTHORIZ�I; 414D — <br /> : /�, �'" FACILITYIdD LOCATION: <br /> CITY,STATE <br /> jai +—C <br /> SERVICE REQUESTED: <br /> TANKJuNE TIGHTNESS TEST LJ FACILITY Ih.S'ECTION <br /> VAPOR RECOVERY TEST n ENVIRONK'ENiAL REPAIRS <br /> OTHER <br /> SERVICES PERFORMED' /•'��"'"" <br /> Sy <br /> ius portion must be V.atr�gletno by the Fsld Lechr'K"+e�sa:ti time am �o:eil within a dRpenscr or tank c4 mp. <br /> aver it that wrA rsrlY C» su of a visaal mpecti�n. 3c rljstritwic�l as dt;sgrated On the lwtmm o!eedr i wm. <br /> 1VSF mX=mka►IORMS A S TtECEss yl <br /> LIQUID SENSOR CONDITION UPON ARRIVAL IDisp a,Tank 161 <br /> location ID' <br /> p.�, Tank IDV )catim ID:_ <br /> I ncation .1 Anr I uation: <br /> Sump f DDC f Ann�1aT <br /> Sensrn Type: Mectani al J //��c I NA :,onsor Type MoGtalical f Flectronic 1 NA <br /> Located witfiet is of icw .i Point Q1 f NA xated withitT 1'of lowest Poing Y 1 N 1 NA <br /> y Iiqutd ptesent Y I N Ouafrtlty:_ <br /> Is liquid present Y f 0 Quartttty _A7`' <br /> Is chain attached to shear v*ve Y 1 N 1�L+c chain atTac Shear valve Y 1 N f NA <br /> UQUIO SENSOR CONDITION UPON DEPARTURE <br /> Has sump lid or dispenser sS <br /> as sitmtp lid at dispenser 4ane4 <br /> ::een Seci:red end 5e2Sed Y f N 1 NA <br /> been secured and Sealed 1 N I NA — <br /> C67))� ARRIVAL TIMI:- DFPARMRE TIME <br /> NUMBER OF PERSONNEL - <br /> TOTAL HOURS(M US MEALS) <br /> NAM Of DEAL ANAGER <br /> PRINT <br /> SIC,NATURE ' SIGNATURE OF DEAl,-ERJMANAGER <br /> Tanknology Inc. 8501 N. MoPac Expressway, Suite 400,Austin,Texas 78759 <br />