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Project Name I AWAAp f tp p LL 4VAIXE <br /> Inspector's Name �SUty JQSN A?j I ENGINEERING <br /> Unit Tested W V-- F <br /> Date —22-0 d - <br /> ANNUAL LCRS,CONTINUITY TEST INSPECTION <br /> (A)TRACER DYE PRE-TESTING PHASE <br /> 1. Is the LCRS sump pumped for liquids prior to testing? yes-_X no <br /> 2. Was a pre-testing LCRS sample collected for observation? yes )1, no <br /> 3. If the sump was not pumped prior to testing,state reason: NA <br /> 4. Is the entry port free and clear of accumulated debris? yes no <br /> 5. Are any repairs needed to the port prior to LCRS continuity testing?yes no- <br /> 6. Total number of ports that require repair: <br /> 7. If repairs are required to the entry port, complete a Maintenance Work Order(MWO). <br /> Comments: /VD C�,_S hktAl <br /> (B)TRACER DYE INJECTION PHASE <br /> Tracer Dye Used: gu 1"VA1t_11Vi cM N F Unit: &10 <br /> Ptart time of tracer dye injection: 1® Tank Start Reading(gal.): 2-&otop time of tracer dye injection: 1/ 26 Tank Stop Reading(gal.): 0' <br /> Total volume of tracer dye mixed(ml) : 90 Mk <br /> Total volume of tracer dye solution injected in the unit(gallons): 2M' t`O <br /> Average flow rate of injected tracer dye solution(gallons per min.): g ' <br /> Comments: ltct r „ia, Q,. �Q <br /> Q- ALZX� J AP, ,/ry1n >yvik Hy 9W.;6'0,, <br /> Remedial Action Work Order Date Completed Signature <br /> Signature of Inspector <br /> e <br /> is <br /> Page 1 of 2 <br />