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f�)W*: <br />Vr I • <br />IT ELLS <br />Well Number 1 2 <br />3 4 <br />5 8 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12` <br />Well Depth <br />De th to Witter <br />Product Detected <br />AIMOUNT in <br />Standard Symbols for diagram below. ®Fill ® Vapor Recovery <br />/B V.R. w / Ball Float <br />o Monitor Well O Observation Well <br />(Outside Tank Bed Area) O (Inside Tank Bed Area) <br />© Ball Float ® Tank Gauge Vent <br />FMIanway 1 Iron Cross T Turbine <br />Location 1 C -Include the.Vapor Recovery System. . . <br />-{Z e M o N. t 5 � <br />. <br />. <br />. . . .�� - 10�o ,tiff. . <br />Cfi <br />(� <br />. <br />. <br />. . . . . . . . . <br />. . . . . . . . . <br />� <br />.................. ....... <br />• V <br />c� <br />. . • . . . . . . • . . . . . <br />.................. ....... <br />. <br />. <br />.................. <br />.................... ©a(l . <br />.........................mss <br />............................. <br />............................. <br />Vapor Recovery <br />System & Vents were tested with which tank? <br />Parts and <br />Labor used / a KV 10 (1 ,ti C �, <br />IL L,J G�Q 5A C a v rt- S 9 7Lt!7� <br />_5'6--tCt-- 2 vl S%P. <br />General Comments - <br />LD J A,/ a C � C— i� C.✓ <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />NAME <br />DATE <br />TI E <br />T: <br />Phone# OWNER or Regulatory Agency <br />FILE NUMBER <br />Pnnt: Certi ed Testers Name <br />Vacuiec" Ce cation Number <br />'S +&j &AJ L, ��-t�tJ1.SS <br />oC' g 3 <br />Ce' 'ed Testers Signature <br />Date Testing Completed <br />1011v -TarACWLft*QW <br />