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Tracer Research Corporation <br /> Site Information For Enhanced Leak Detection Sites <br /> Submit Completed Form With Each Job! <br /> Technician �� Job# ' oo 314Date ( 2_ - (q , o <br /> Site Name w"a ChLE1 )W? - <br /> Purpose of test: (Product on water table Within 1000of we mestable secondary containment? Regulatory directive? New Installation? Emergency <br /> Generator? Consultant recommendation? otheTy <br /> CUPA Oe2ulatory re ion): <br /> Spill Bucket Test, TKl (Pas , TK2 ('Fail) TK3 (Paste TK4 (pas ai. TK5 (Pass/Fail) TK6 (Pass/Fail) <br /> Fyne of Sump Pump (Suction) urbine <br /> gent Line Probes <br /> Vapor Recovery Line Probes�,Ay I t cj <br /> Tunes of Backfill <br /> Tank Pit ►JC P;A <br /> Line Trench M CA?— C-OEM/P/l <br /> Ground Cover (Concrete (other) <br /> Ground Cover Condition (Excellent) (Good) (Fair) oo ) (other) <br /> List All Component Types <br /> Tank (Single Wall) uble (Steel) her 1 (other) <br /> Lines (Single Wall) ouble (Steel) tber (Fibemench) (other) <br /> Vent Lines (Double Wall) (Steel) (Fiber 1 (other) <br /> Vapor Recovery le W (Double Wall) (Steel) iberglass- (other) <br /> Vapor Recovery (Assist) <br /> Sump Construction: Sealed to tank t (Dirt) (Retrofit—bolted to riser at tank top) (Retrofit—bolted to manway) <br /> Spill Bucket,Plunger Type etc SPL) <br /> Overfill Protection &2L C &Nt d/1 <br /> Tank Fills ,Iyu <br /> Tank.Manifolds .✓ <br /> Monitoring Well (Locations and deaths) <br /> Water in Sump: YES Depth from surface: <br /> Water in Line trench: YESN7i,7R Depth from surface:. <br /> Water in tank pit: YES / COP Depth from surface:__N.& <br /> Line Leak Detectors <br /> Fibertrench descriMion: <br /> Composition: <br /> Shape(draw picture if necessary): <br /> Depth to top: — 'fl �I- � <br /> Signature of site person verifying condition of site at end of installation: $, , <br />