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Site Plumber of "! V Date C <br /> nP• stave u Type <br /> Vapor Pot prettatrre�nagertfertt Syabm EM 8y81IffWW,2RECEIVED <br /> Enhanced Vapor <br /> Wes the site <br /> VB=Vac Assist have a� CAS=Healy Clean Air Separator Recovery J U L !_ 3 2018 <br /> 2P=Two Point BL=Balance <br /> VR=VR Carbon Canister <br /> CP=Coax poppeted VST=Vaporpot(drop o� <br /> Sys Tech VST=VST Vapor Processor ®W=EBW VR <br /> CN=Coax Non-poppatetank) List any other PT-PHIL TITS <br /> NA=No Stage Il Yes allo NA=Outside of California OP z N SVR <br /> I NA ENVIRONMENTAL <br /> Q HEALTH DEFA.RTMENT <br /> Tank6 ' Drys;e86" .ery+'$^ '40T VBrttPlpea _w_.'r� VarttCaps.?. ..t : 7 <br /> Proper Operating there a separate vent for Aro the vent Impact Protaction Condition H OH sky , Condition <br /> Order Condylion each tank P M=Morrison Bras <br /> per tank manifolded B=BoBards OK=Secure NA=No Vent Model# OK=Good condition <br /> monitor Yes or No Yes or No together? A=36'from pub NS-Not secure mardolded NC-Not in good Gond. <br /> NA--No dry break Yes or No N=Nona NA=No vent cap <br /> NO=No Vent Present <br /> ' � •� � K S�� OLS <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> UST Monttoring Ar.YIVA <br /> Nanur_Luror BodMNtanbtr rr Prkdtr 1 ry• Tank Prnbee f ;yr 8oHMett Vortion <br /> VR=Veeder Root Does the Do all tanks have probes installed and YWhere are the tank probes installed? <br /> connected to the system?H root provide <br /> R Ronan Mondor have a F=Fel Sump <br /> I=Incon Wnte Model Number p.1tar? notes on bung avallabitlty&any other T=Turbine Sump Write Software Version in <br /> N=None Install notes below. Other explain space proved <br /> Other fist Yes or No Yes or No NA-No Proms <br /> � t7 s ce x;,� ,an sump Se taor edatona x� . <br /> sok& fa a fHl'astrttp tiataDed Sump Coriditlon a Ai tarp dmt R}dry '.. ro-.- u'1Manvmy L(d' <br /> "` ;-�3=§r�,,>?.usaPoai8onl i'dr irtatet `6_kS .T.a a <br /> If p ta tformtgra to is <br /> Iniad and in proper condrtion W=Water present if sensor is installed,is it present m sump,�rt s In place and in proper <br /> Order CS=Containment Sump ("plain in comments below) F=Fuel present at the lowest point proper condition? <br /> Fl <br /> NA No Fill Sump condition <br /> per tank SB=Ridged Sod Barrier D=Debris present <br /> monitor N=None Yes No CO=Clean and Dry Yes or No Yes or No <br /> = <br /> (Circle all Yes or No that apply) NA=No Sensor NA=No to NA=No sump <br /> 1 C,S W F D CD P <br /> z asL W F D ® pF f <br /> 3 CS W F D CD <br /> 4 W F D CD <br /> 5 W F D CD <br /> 6 W F D CO <br /> Comments on any damaged/defective equipment <br /> issued 12/27/2017 Page 2 of 10 <br />