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JNN� Ask <br /> Tracer Tight ® S ITE I N F O RMA 10 N F 0 R M <br /> Inoculation � _� TracerTight® 11061 State <br /> Technician ID # License # <br /> Tracer lob # Sampling /l Z �acer'1'ightQD //0J License GV �'�'7✓ <br /> State <br /> Technician i'Fi� <br /> Site <br /> Name G �/ <br /> Affilhate Site <br /> f�Q Address 1 y - State �, zip �- <br /> Precision Test ❑ Leak Delineation ❑ 1 ! �o y � Y Depth to ground water in tank pit <br /> Initial Test ❑ All Water Ingress ❑ Inoculation date l at inoculation/initial visit (in inches) y in <br /> o <br /> (see boa at right) Depth to ground crater In tank pit J/� <br /> Annual Test ❑ Monthly Monitoring ❑ i Sampling date /J / /0 at sampling/second visit (in inches) 1 [ in <br /> I <br /> Retest ❑ To be used for ALL plater Ingress Tests <br /> ❑ -E1� Tank(s) were constantly do completely ❑ <br /> Result Verification Maximum Sample Vacuum <br /> submerged in ground water for the <br /> Residential Tank <br /> (s) E] (Highest probe Vacuum on site) in Hg duration of the test ? YES NO <br /> o wo At inoculation At sampling .. n P m ro K b � <br /> Tank No Product a#@ Volume A Q a p "� HBO level Uqui HBO level Total Ilquid o + a � ay (ln gallons) in tanklevel to tnnk levelo <br /> o <br /> x..i P o m rr ,.r Z O O e�. err .. ° in inches)ITatal <br /> (La lncheE (in inches) (in incheE o tr er■ n `� e <br /> ❑ .9 ❑ ❑ .e <br /> �. 4I9 12�b 31 10l 1 So <br /> © �2 000 31•� 1 V0 2,3 �' ° NO <br /> ❑ 3v <br /> 3 $ - ° NO in NO <br /> [Z Oo� 3�.$ ►! o a l5 <br /> El El <br /> ❑ El <br /> YES NO Til No TEs No <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> TO No Tn NO US xo <br /> ❑ ❑ <br /> ❑ <br /> TE9 NOTinX0 TEs No <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> YES NO TR9 NO Y" No <br /> ❑ El ❑ ❑ ❑ ❑ <br /> YE9 NO Y® NO TES NO <br /> Comments -------------------.-_---------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------- <br /> -------_.. ------------------------------.---------------------------------------------------------------------- <br /> Rensed 8-27-98 Rev 03 Tracer Re.teirti Cerpartflo® <br />