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g,1 r y <br />_ OIL COMPANY TIFZC TION OF UNDERGROD SYSTEM <br />Facility WIC Number : Districts 28 <br />Facility Address <br />Purpose of Visit <br />Tank/Line Material [}q Steel [ ] Fiberglass <br />Product Tanks [] Single Wall [ ) Double Wall <br />Product Lines [ ) Single Wall [ ) Double Wall <br />Waste Oil Tank [ ] Single Wall Double Wall <br />[ ) None <br />Product TAnk Monitoring system <br />QTY TYPE <br />[ ] Interstitial Monitor [ ) Wet [ ) Dry <br />[ ] Vadose Zone Monitor <br />[�] Monitored Visually (Daily Inventory) <br />Manufacturer: [ ] API Reservoir <br />[ ] API MOS(VADOSE) [ ) Genelco <br />[ ) OC [ ) Pollualert <br />[ ] Soil Sentry [ , Spearhead <br />� <br />ode : _ l <br />Status @ Arrival: Operational <br />Corrective Action: [ ] Performed <br />Status @ Departure: Operational <br />r <br />Ivo weay o,I .5/�e <br />Product Line Monitoring system <br />[ ] API IR(VADOSE) <br />( ] Leakalert- <br />[ ] Red Jacket <br />[ ) Other: <br />Pon -operational <br />Required <br />Non-operational <br />M4 <br />QTY TYPE <br />[ ] Electronic Line Pressure Monitor w/ Mechanical Leak Detector <br />[ ] Interstitial Monitor w/ Mechanical Leak Detector <br />[3j Mechanical Leak Detector Alone <br />Electronic Line _Pressure or Interstitial <br />Monitor Manufacturer: <br />[ j API Pressure <br />[ ) <br />API Sump [ ] API Sump/Line <br />[ ] Leakalert <br />( ] <br />Other ... <br />Model: :2 L0 LVL <br />D <br />Pcd '_ <br />Status @ Arrival: <br />[ <br />Operational [ <br />] Non -operational <br />Corrective Action: <br />[ ] <br />Performed [ <br />] Required <br />Status @ Departure: <br />[\1 <br />Operational [ <br />] Non -operational <br />