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bp " �734W #126909 <br /> WORK ACKNOWLEDGEMENT FORM A <br /> 0 'Nor <br /> E-MAINTENANCE TICKET NO: DATE: Z2- 2, 11 <br /> FACILITY NO.&ADDRESS: <br /> G T-rfl-ER-RYAN <br /> VENDOR NAME&ADDRESS: 747SIERRA COURL�1 � <br /> SERVICE REQUESTED: <br /> 0 TANK/LINE TIGHTNESS TEST U FACILITY INSPECTION U ENVIRONMENTAL REPAIRS <br /> U VAPOR RECOVERY TEST U SECONDARY CONTAINMENT TESTING LrOTHER(A1414Uot <br /> C(ALARM TYPE AS LISTED ON VEEDER-ROOT PANEL jl�Z267kc:>4�, <br /> 'k <br /> LOCATION OF ALARM U SUMP NO. Q UDC/DISPENSER NO. U ANNULAR TAN NO. <br /> ALL ALARMS CLEARED U Y U N <br /> PLEASE PRINT LEGIBLY, �D Apjldfg�- 101A 4 LAI, e--Iw LZ A?Z4 Cc,z <br /> 1 -0. V <br /> im <br /> /'jdF, e f3 <br /> 4 4 <br /> Ca s <br /> 1r, <br /> zg Azz <br /> a I P L 4- <br /> b <br /> LSub:e, kNf-Le-4 Nne y", A#1 <br /> --A KIT2", 0-c-t-4n MM DEC. 1 2 2011 <br /> f \,Hours <br /> 4�- <br /> 4 <br /> Are all sensor(s)located at the low t point? Chain attached to shear valve? Debris removed from UDC? <br /> UY UN UNA UY UN UNA UY UN UNA <br /> Have all sump lids and dispenser panels been Q ECS Notified of liquid found in Vapor equipment repairs <br /> secured and sealed? U Y U N U NA containment sumps documented in Repair Log? <br /> only if no sumps or dispensers were opened. Q UN UNA <br /> NU R OF PERSONNEL ARRIVAL TIME DEPARTURE TIME I 3 <br /> f <br /> OW7 bo <br /> A <br /> tk--4� All TOTAL HOURS (MINUS MEALS) <br /> TECHN PRINT NAME NAME OF DEALER/MANAGER <br /> 4 <br /> TECHNICIAN SIGNATURE SIGNATURE OF DEALER/MANAGW <br /> DISTRIBUTION:WHITE-Invoice copy CANARY-Site Copy/ PINK-Vendorcopy <br />