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Tracer Tight ® S I T E I N F O R M A T I O N F 0 R M <br /> Inoculation TracerTight® )�06 1 State <br /> Technician ID #: License # O 16 52 <br /> Tracer Job # $lpNSl Sampling TracerTight® State <br /> Technician Fe Wtr Sp'rp ID a066 license # Oi•1460 <br /> Site I <br /> Name Man2 LWor Q <br /> y�J Gen <br /> Affilliate 2 Site Address <br /> - <br /> Address U O city MOQ�era. <br /> Statecf, Zip 5 <br /> Precision Test ❑ Leak Delineation ❑ Depth to ground water in tank pit [� <br /> Initial Test ❑ All Water Ingress Inoculation date . IoL /Q /Q y at inoculation/initial visit (in inches): � ' Y D in. <br /> (see box at right) ❑ Depth to ground water in tank pit <br /> nual Test ❑ MonthlyMonitoring / at sampling/second visit (in inches): / y in. <br /> B ❑ Sampling date 't 2 p Q / <br /> Retest ❑ � To be used for ALL Water Ingress Tests <br /> Result Verification 117�`J Y} Maximum Sample Vacuum Tank(s) were constantly & completely ❑ ❑ <br /> submerged in <br /> Residential Tank(s) El (Highestof the <br /> test <br /> (Highest probe Vacuum on site) in Hg water for the YES NO <br /> _ est .v <br /> At inoculation At sampling <br /> p ..,Oo ¢'< m^ <br /> Product ° aTank No. Total u wd H olevelTetel144and <br /> rxoe+ y + <br /> vB H olm(in gallons) <br /> e6s <br /> v a p m $ n in inches) (in inches (in inches) (in inches �L o t, ° p'• — C s y <br /> `ate ❑ ❑ [ ❑ r>?t ❑ <br /> na NO bpm 8X .5 AIDS 2 D 36 ZS NO no NO Y5•. <br /> Cl ❑ ❑ Imo ❑ no ❑ y „ <br /> us NO 00D d ) o lam' ( i Q '� vss No no No <br /> 3 L o NO bob g 5 �N9 IJP 2� 2s 1 � NO no NO NO NO j Li <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> us No M NO ns No <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> ns NO ns NO na No <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> no NO Too NO Yds NO <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> na NO - na NO ns NO <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> Yes NO Y® NO no NO <br /> Comments_____________________________________________________________________________________________________ <br /> Revised 0-27-99 Rev. 03 <br /> Tracer Researcd Car/oiilioo <br />