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CO-ti- 0�rl� <br /> 4- --ct <br /> S.O.# <br /> MONITOR WELLS <br /> Number 1 2 3 4 5 6 7 8 9 10 11 12 <br /> Depth <br /> Water <br /> Prod. DetectedZ� <br /> NOT Det. <br /> Location Diagram <br /> D_ IC' <br /> D`o14 <br /> D U <br /> f <br /> Parts and Labor used <br /> General Comme is '-7-M-*-/II <br /> S- <br /> r t <br /> J�L f <br /> When local regulations require immediate reporting of a,system leak—Complete the following: <br /> Reported to: <br /> Name Date Time <br /> Phone Number Regulatory Agency File Number <br /> Print: Certified Testers Name Vacutect(tm)Certification Number <br /> Certified Testers Signature / Date Testing Comp.. ed Form:TestData 1/91 <br />