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• i <br /> Tracer Research Corporation <br /> Site Information For Enhanced Leak Detection Sites <br /> +fit Submit Completed Form With Each Job! <br /> Technician 1 `' Job# 9 T GCS SL-1 Date [ 2- t qy <br /> Site Name KdV-� Cti )� <br /> Purpose of test: (Product on water tablet/ Within 1000'of we� ntestabte secondary containment? Regulatory directive? New Installation? Emergency <br /> Generator? Consultant recommendation? <br /> CUPA(regulatory region): <br /> Spill Bucket Test: TKI (Pass, TK2 (Fail) TK3 (Pagg TK4 (Pass ai TK5 (Pass/Fail) TK6 (Pass/Fail) <br /> Type of Sump Pump (Suction) urbmie <br /> Vent Line Probes N[9le� 1 a f'J�, <br /> Vapor Recovery Line Probes <br /> Tomes of Backfill <br /> Tank PitADC-, �1:� Fr/L"e/L <br /> Line Trench `I'I� Pep/L <br /> Ground Cover (Concrete 6� (other) <br /> Ground Cover Condition (Excellent) (Good) (Fair) oo ) (other) <br /> List All Component Types <br /> Tank (Single Wall) able . (Steel) her 1 a (other) <br /> Lines (Single Wall) Double (Steel) tber (Fibertrench) (other) <br /> Vent Lines (Double Wall) (Steel)J�ibcrglass <br /> iber 1 (other) <br /> Vapor Recovery le W (Double Wall) (Steel) (other) <br /> Vapor Recovery (Assist) <br /> Sump Construction:qSealed to tank t (Dirt) (Retrofit—bolted to riser at tank top) (Retrofit—bolted to manway) <br /> Spill Bucket,Plunger Type etc. C P�O <br /> Overfill Protection �Grli4 MLLI�C <br /> Tank Fills <br /> Tank.Manifolds ✓ <br /> Monitoring Well (Locations and deoths). <br /> Water in Sump: YES Depth from surface: <br /> Water in Line trench: YES Depth from surface: <br /> Water in tank pit: YES / � Depth from surface:---aA <br /> Line Leak Detectors <br /> Fibertrench description: <br /> Composition: <br /> Shape(draw picture if necessary): <br /> Depth to top: <br /> Signature of site person verifying condition of site at end of installation:I�A <br />