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by CA Supplemental Information <br /> Site Number Date <br /> 2 !V'f�,��' � <br /> unikRi `` aterf i _ ;: <br /> Q R��'oni"`". _ens..� '�NI_ i l sfnf"._fin <br /> DWF=DW Fiberglass DWF=DW Fiberglass <br /> SWF=SW Fiberglass SWF=SW Fiberglass <br /> Order per VR=Veeder Root Write in the model number SWS=SW Steel SWS=SW Steel <br /> tank monitor Other:please write in DWFLX=DW Flexible DWFLX=DW Flexible <br /> SWFLX=SW Flexible SWFLX=SW Flexible <br /> UNK=Unknown UNK=Unknown <br /> 1 W- <br /> 2 v� cto <br /> 3 vtoll <br /> 4 <br /> 5 <br /> 29 tea'p -gip _g "4 f + Ya a P ing <br /> IN7 E(Tp'37�7 ��]$�. INTEi 'ITF,►t� �n �� ' <br /> INTERS ,l#�t$eltaor� NTEF�SfiiFALnac <br /> Order per Write Manufacturer&Model Number in the space provided <br /> tank monitor UNK=Present,Can not determine <br /> NA=No Sensor '° <br /> 1 .J ��� D <br /> 2 <br /> KIL 2018 <br /> 3 <br /> 4 VIRQNMENTAL <br /> HEIN TI-# F?EP�.R7�1?ENT <br /> 5 <br /> e i`FEItM1 fi F `��aL s ns al , V o <br /> Write Manufacturer&Model Number in space <br /> provided Write Manufacturer&Model Number in space provided <br /> Dispenser# Dispenser# <br /> UNK=Present,can not determine UNK=Present,can not determine <br /> NA=No Sensor NA=No Sensor <br /> 112 9/10 <br /> 3/4 11/12 <br /> 5/6 13/14 <br /> 7/8 15/16 <br /> issued 03/22/2018 Additional Page <br />