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SO#- ( Owner: X oeo 6 Site# Syg <br />MONITOR WELLS <br />Well Number 1 1 2 3 4 5 6 7 8 <br />9 10 11 12 <br />-Well Depth 'f <br />De th to Water ? <br />Product Detected <br />AMOUNT in Inchea <br />Standard Symbols for diagram below: F Fill <br />/B V.R. w / Ball Float @M Monitor Well <br />(Outside Tank Bed Area) <br />B Ball Float. G Tank Gauge <br />M <Manway L'J Iron Cross. <br />V Vapor Recovery <br />p Observation Well <br />(inside Tank Bed Area) <br />O Vent <br />T Turbine <br />Location Dlagram-lnclude the Vapor Recovery System. <br />�iIMMEP .LA/ <br />................... <br />•_ Ntp JN •SJu (jJd <br />. _ NLP uN SuulkuN <br />I <br />. .. . <br />1 <br />• MG9).M A <br />. . . . . . . . . . . . . . . <br />Vapor Recovery System &;)lents were tested with which tank? <br />N <br />_ <br />n( <br />g T <br />N <br />SJN L <br />. . . . Q <br />Parts and"Labor-used <br />GeneralComments <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />TO: <br />NAME <br />DATE <br />TIME <br />Phone# <br />OWNER or Regulatory Agency I <br />FILE NUMBER <br />Print Certied Testers Name <br />Vac Certification Number <br />Certified T rnature <br />Date Testing Completed <br />9 <br />/V PA 1NOutarwiMn <br />