Laserfiche WebLink
�--by 1601Y.3�� <br /> # 197365 <br /> ®® <br /> z WORK ACKNOWLEDGEMENT FORM <br /> IV <br /> E-MAINTENANCETICKEf NO: /Q/504 z DATE: 7 <br /> FACILITY NO.&ADDRESS: . S &0a, 3 <br /> VENDOR NAME&ADDRESS: , <br /> X0.5 <br /> SERVICE REQUESTED: <br /> U TANKILINE TIGHTNESS TEST U FACILITY INSPECTION U ENVIRONMENTAL REPAIRS <br /> UVAPOR RECOVERY TEST U SECONDARY CONTAINMENT TESTING U OTHER <br /> U ALARM TYPE AS LISTED ON VEEDER-ROOT PANEL <br /> LOCATION OF ALARM U SUMP NO. U UDC/DISPENSER NO. !]ANNULAR TANK NO. <br /> ALL ALARMS CLEARED U Y U N <br /> PLEASE PRINT LEGIBLY <br /> s s - 2 s✓ 3 d <br /> 4 - S <br /> P <br /> Are I sensor(s)located at the lowest point? Chain attached=NA <br /> ear valve? Debn emoved from UDC? <br /> �� U UN VUN ONA <br /> YY UN >NA <br /> Have all sump lids and di§Kenser panels been L7 ECS Notified of liquid found in Vapor equipment repairs <br /> secured and sealed? 0 Y U N U NA containment sumps documented in Repair Log? <br /> �Vq onJy ii no sumps or dispensers were opened. U Y JN U NA <br /> L------- - 3� DEPARTURE TIME S ' q(o <br /> NUMBER OF PERSONNEL Z ARRIVAL TIME <br /> TOTAL HOUR MINUS MEALS) �1 <br /> TECHNICI R NAM NAME Of R/MAN R: <br /> TECH AN SIGNA URE <br /> SIGN 4 F DEALER/MANAGER <br /> [IS IBiJTION WHITE -invare copy / CANARY Srte copy/ PINK Vendor copy <br />