COMPLIANCE INFO_2003-2009 - Laserfiche WebLink

Home Browse Search

Tracer Tight ® S I T E I N F O R M A T I O N F 0 R M Inoculationeoc�8 TracerTight® /lobi State �3 r to Technician :twin ID #: License # Tracer Job $ _ L Sampling TracerTight® State Technician bWtY-, cry&(. , ID #: lt0(,t License # : a3_ Precision Test ❑ Leak Delineation ❑ Site Name Depth to ground water in tank pit u - inoculation/initial Affilliate Site at visit (in inches): , IVin. Address 201 City State Zip Precision Test ❑ Leak Delineation ❑ Inoculation date /?� /® 1/ Depth to ground water in tank pit u - inoculation/initial Initial Test ❑ All Water Ingress ❑ '® at visit (in inches): , IVin. /®� /®� Depth to ground water in tank pit 1, at sampling/second visit (in inches): ! �%�% in. (see box at right) nual Test ❑ MonthlyMonitoring ❑ B Sampling date i� To be used for ALL Water Ingress Tests Retest ❑ T2Z?05Maximum Result Verification ❑ Sample Vacuum Tank(s) were constantly & completely F-1 ElResidential Tank(?) (•) ❑ (Highest probe Vacuum on site) in Hg submerged in ground water for the duration of the test ? YES NO n„ W"o op a ° mNa" At inoculation At sampling -w, a°"ppa nv mmsm. b® ® No. Product Volume g no "o G gmH2O a oTank o 4 .�' level l Uqul H2O level Total Lquid notis oym(in gallons) p m n tank le vel in tank level c Wem Z ® " va Cr m o m ?in )Tta inches (in inches (in inches (in inches o dam; � ❑❑ YES No t 1. �0 33 No YE NO YES NOo NO Io 8xAtom�. �a s 4 YE NO Y29 NO 3 ❑❑ YES NO e. uo 39 YES NO .NO X43 ❑ ❑ ❑ ❑ ❑ ❑ 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 Tr'Cer RCs08rel CBrporil 0®