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Tracer Research Corporation <br />Site Information For Enhanced Leak Detection Sites <br />Submit Completed Form With Each Jab! <br />Technician M �L ��- Job # S-�1�6Lk Z Date I- k u - O S - <br />Site Name KWLV. 56iw6 C�ScO 'v l - w:t STAT l "C -t C'A, <br />Purpose of test: (Product on water to <br />Generator? Consultant recommendation? <br />Untestable secondary containment? Regulatory directive? New Installation? Emergency <br />CUPA (renulatory regrion): <br />Spill Bucket Test: TKl (Pass/Fail) TK2 (Pass/Fail) TK3 (Pass/Fa") TK4 (Pass/Fail) TK5 (Pass/Fail) TK6 (Pass/Fai <br />Type of Sump Pump (Suction) Turbine. RFD SPAt:."'T <br />Vent Line Probes <br />Vapor Recovery Line Probes <br />Twes .of Backfill <br />TankPit E PJ C4, JE E a ie P C A^v e-�- <br />Line Trench <br />Ground Cover onerete halt (other) <br />Ground Cover Condition (Excellent) (Good) q9 (Poor) (other) <br />List All Component Tunes <br />Tank (Single Wall) <br />ouble Wal <br />Stee <br />fiberglass <br />(other) Ftp Oz iW -o ric e n <br />Lines (Single Wall) <br />Vent Lines Single <br />(Double Wall) <br />(Steel) <br />tber lass <br />(Fibertrench) (other) _O _ S r� ► t Ft <br />Wal <br />(Double Wall) <br />(Steel) <br />(Fiberglass <br />(other) MtT tit <br />Vapor Recovery (Single Wall) <br />(Double Wall) <br />(Steel) <br />fiberglass <br />(other) <br />Vapor Recover+ (Balance) (Assist) <br />Sump Construction, cgiEtankto (Dirt) (Retrofit- bolted to riser at tank top) (Retrofit- bolted to manway) <br />Spill Bucket Plunger 1=etc, (DPu--) 210b S e-R%C-S <br />Overfill Protection Mec"I N 1CA10 - _ <br />Tank Fills <br />Tank,Manifolds ut N- t o L t <br />Monitorne Well (Locations and dentbs). <br />Water in Sump: YES I(NO) Depth from surface: <br />Water in Line trench: YES /0 . Depth from surface:. <br />Water in tank pit: YES J Depth from surface: <br />Line Leak Detectors <br />FiboVrench descri0on- <br />Composition: <br />Shape (draw picture if necessary): <br />Depth to top: <br />Signature of site person verifying condition of site at end of installation: <br />