COMPLIANCE INFO_2005-2012 - Laserfiche WebLink

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Tracer ® S I T E I N F 0 R M A T I O N F 0 R M StateInoculatioTracerTight® tooSZ Technician (� �G�¢ s l,t ID #: License # Tracer Job # STC)C) - Z Sampling•^^ TracerTightm State Technician ID 1'v' t (,1Q� License # Precision Test ❑ Leak Delineation ❑ Site / n � Name Depth to ground water in tank pit VE-LoND inoculation/initial (in inches): tSO in. Affilliate (, C, " J Inoculation date Z Site Address �So W. l �TYi L�7', City : T( -Ac, -i State : CA Zip : 9C3 Precision Test ❑ Leak Delineation ❑ / L S ,� Depth to ground water in tank pit VE-LoND inoculation/initial (in inches): tSO in. Initial Test All Water Ingress❑ Inoculation date Z at visit Depth to ground water in tank pit (see box at right) Annual Test ❑ Monthly Monitoring ❑ Sampling date / 2� / OS (in inches): at sampling/second visit in. 5o Retest ❑ To be used for ALL Water Ingress Tests Result Verification Maximum Sample Vacuum Tank(s) were constantly & completely El �J� Residential Tanks () ❑ (Highest probe Vacuum on site) in Hg submerged in ground water for the ONKi duration of the test ? YES NO ° P H P. '7 oAt inoculation At sampling P) n u T '=b s -.i3 G' ry No. Product 2. 0c o Volume m 0, G K pTank al Liquid Hlevel Total Liquid ° gallons) o e & level in tank level o o eC °(in inches (in inches) (in inches o W 0, f ANO,00(D g,cZ(o F�rczs ti No '!" 3f3.�" yc.�l' o f NO YES ,�`i Z qt uNI,EAt o 9 LC>3 C7931 2 Nt7 Zl.� �� ii 2$ Z�(YES NO NO l4 -'c .��c , ❑3 YES NO t Vl �� $7c �b E�329 'b a 3 C / l ® ❑ YES NO El WS NO ' H 4+ t , ❑ ❑ ❑ ❑ ❑ ❑ YES NO YES NO YES NO ❑ ❑ ❑ ❑ ❑ ❑ YES NO YES NO YES NO ❑ ❑ ❑ ❑ ❑ ❑ YES NO YES NO YES NO ❑ ❑ ❑ ❑ ❑ ❑ YES NO YES NO YES NO ❑ ❑' ❑ ❑ ❑ ❑ YES NO YES NO YES NO Comments :_______________ -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- Revised 8-27-98 Rev. 03 Tracer Resented Cor,00ralioo i