Laserfiche WebLink
by #204089 <br /> ALAN 2 0 2019 AL <br /> WORK ACKNOWLEDGEMENT FORM <br /> E MAINTENANCE TICKET NO: DATE: <br /> FACILITY NO.&ADDRESS:\.C)56> 1 rj L��l1S d LRt�H <br /> ei 19yd <br /> VENDOR NAME&ADDRESS:' �'y V"M05 Sierra Cour{ Suli2 , G <br /> SERVICE REQUESTED: ubrih, CA 0/1558 <br /> ❑TANK/LINETIGHTNESS TEST ❑FACILITY INSPECTION ❑ENVIRONMENTAL REPAIRS <br /> ❑VAPOR RECOVERY TEST ❑SECONDARY CONTAINMENT TESTING ❑ OTHER <br /> ❑ALARM TYPE AS LISTED ON VEEDER-ROOT PANEL <br /> LOCATION OF ALARM ❑SUMP NO. ❑ UDC/DISPENSER NO. ❑ANNULAR TANK NO. <br /> ALL ALARMS CLEARED❑Y ❑N <br /> PLEASE PRINT LEGIBLY:C ��"' <br /> `/ <br /> FEB 12 <br /> Are all sensor(s) locatpgj at the lowest point? Chain attached to shear valve? Debris removed from UDC? <br /> �'%kY U ,U� ❑ Y ❑ N r '� ❑ Y ❑ N ❑ NA <br /> Have all sump lids and dispenser panels beep ❑ECS Notified of liquid found in Vapor equipmen epairs <br /> secured and sealed? ,Y ❑ N FJ NA' � containment sumps documented in Repair Log? <br /> A only if no sumps or dispensers were opened. ❑ Y ❑ N ❑ NA <br /> NUMBER OF PERSONNEL ARRIVAL TIME `-D,. DEPARTURE TIME <br /> TOTAL HOURS (MINUS MEALS) 3 <br /> TECHNICIAN PRINT NA 1E NAVE OF DEA MANAGER <br /> TECHNICIAN URE SIGNATURE OF DEAL ANA <br /> DISTRIBUTION: WHITE- Invoice copy / CANARY- Site copy/ PINK-Vendor copy <br />