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ecer Tight ® S I T E I N F 0 R M A T 1 0 N F 0 R M - <br /> Inoculation TracerTight® S;L State q[� <br /> ��0�3L1 Technician 0t �(, _ ID #: /�v License # <br /> Tracer Sob // }l•-�/• / Sampling 1/2��L TracerTight® �0 2 State <br /> Technician �J,��\/�l� ID t s License 'vy - <br /> Site <br /> Name I t0P1,PviA )AeIRON <br /> Affilliate G7 its Address I �7u' lJ.. -tWY C(� city : S\\f �-T'0t3 :C p <br /> O p ) State Zi <br /> Precision Test ❑ Leak Delineation ❑ \ Depth to ground water in tank pit ��v/ <br /> Initial Test All Water Ingress Inoculation date a / to / ©5 at inoculation/initial visit (in inches): ` T N in. <br /> ❑ (see box at right) ❑ Depth to ground water in tank pit n • <br /> Annual Test Monthly Monitoring El Sampling date at sampling/second visit (in inches): l� in. <br /> Retest - To be used for ALL Water Ingress Tests <br /> Result Verification ❑ Maximum Sample Vacuum Tank(s) were constantly & completely ❑ f:JI <br /> Residential Tank( ) sub(Highest probe Vacuum on site) N in Hg submerged in ground water for the L�I <br /> duration of the test ? YES NO <br /> inoculation At sampling <br /> w�oE e. B y n <br /> -mc o 0o aC Egnliquid <br /> "Tank No. Product e= Volume elevel Total g <br /> . ry (in gallons <br /> in teak level O <br /> Zw <br /> (in inches) (in inches ,°. o tr <br /> n <br /> l Ut L&APer, 0 V. 3 ,Oop 9><3t( swr �8o I l N� s `I " 4"--S r. `�� Sn p NO YES NO <br /> O <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> YES NO M NO TES NO <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> THS NO YES NO YHS NO <br /> 01:1 ❑ ElElElTEs NO Yb No INS NO <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> TES NO YES NO THS NO <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> ns NO TES NO "a NO <br /> ❑ ❑ L-0 <br /> E:1 Elns NO MNO <br /> El ElEl ❑ <br /> ng ND YEs NO <br /> Comments___________________________________________ ________________________________________________________ <br /> Reviled 3-27-99 Rev. 03 <br /> Tracer Research Corparalion <br />