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SO* / 7 z r: Site# q,/1g <br />l Z3 ��✓�ov 3 <br />La <br />111L•f'el'laAWj <br />Well Number 1 2 3 4 5 6 7 a 9 10 11 12 <br />ell Depth R/4 <br />Depth to Water AfIA <br />Product Detected <br />AMOUNT in finches M <br />1,4 <br />Standard Symbols for diagram below: F Fill V 'Vapor Recovery <br />GV.R. w / Ball Float o Monitor Well Observation Well <br />(Outside Tank Bed Area) (Inside Tank Bed Area) <br />© Ball Float ® Tank Gauge O Vent <br />Manway LIJ Iron Cross T Turbine <br />Loc. tl 1 ^ -Include the Vapor Recovery System. <br />. tNaz1 ?J . <br />eAs,4«e- <br />.� . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Soy. .0 <br />0 AAAJ <br />. . . . . . . . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . . . . . . <br />VkaiTS <br />Vapor Recovery System & Vents were tested with which tank? <br />Parts and Labor used <br />General <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />NAME <br />DATE <br />TIME <br />T <br />Phone# OWNER or Regulatory Agency <br />FILE NUMBER <br />Pnnt Certified Testers Name <br />Vacu Certification Number <br />Certified TesieSi na re <br />r <br />Cmpleted <br />7Date'T/esting <br />% / <br />7 - /Z -9t_1 <br />-Ta <br />