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• 4 <br /> •_ .� 11 IBJ <br /> �' i !� L'Z'IF'ICI\'1'IOtt OF Ut:UEll. OUlIU 8Y8TEli <br /> ` �• Facility WIC N <br /> . umber I <br /> facility Address <br /> 1lddressG <br /> -CfC A t <br /> 7V'i <br /> Purpose of Visit <br /> Tank/Lige Material <br /> [ ] Steel DQ Fiberglass <br /> Product 1,att)cs • [ ) Single Wall <br /> Product Lines (3) Double Wall <br /> -Waste Oil 'rank [ ) Single Wall [3) Double Wall <br /> ' <br /> [ ) Single Wall [ J Double Wall <br /> LXJ otte <br /> 'x oc]uct t -, 1lotti tort >>�T <br /> QTY 'TYPE <br /> X37 Interstitial t•lottiLor <br /> Vadose Zone tFlotlitor Wet [ ] Dry <br /> [ ] 2.1011itored Visually ( Daily Inventory) <br /> LL411ufacLt1rer; <br /> [ ] IPI MOS (VADOSL) Gett <br /> Ge lteservvir [ ) API 1)t (VADOSt <br /> •[ ) oC [ ] elcv [ ] Leakalert• ,] <br /> [ ] Soil Sentry [ ] �'°llualert [ ] Iced Jacket <br /> ( ] Spearhead [� Utlte.t_��`�� � n _ <br /> • oc3e _ ����►.1 - 1� 7� LVA (-, 1�c�c, -�-.�,�C� <br /> Status 9 Arrival ! [x] ol)erational <br /> Corrective Ar-tiotl: [ ] Lott-operational <br /> Q Departure: <br /> Status [ ) erlvrtneci [ ) Required <br /> [x-] operational <br /> [ ) Nott-operational <br /> 'rL'Uct Li—I a Lvttitvritta :13 <br /> s <br /> . QTY TYPn <br /> [�] Electronic Litte Pressure l-lonit-or w/ )-lec)tattical Leak Detector <br /> [ ] Interstitial tlottitor w <br /> [ ] i•lechattical Leak DetectorllAlotn�ical Leak Detector <br /> ); e�trrottic Li11e �'z--- eSsuie c'-� l.i�t:et-stiti�l_ t•1ottALor 1•tanuLacturert <br /> [ ] SPI Pressure [ ] Atli Sutj� <br /> ( ] [ ] p [>Q SPI Sutup/Line <br /> Leakalert• otter <br /> v e : Ti OfSki f3 x 7f L V C <br /> Status e Arrival ! (�] Operational <br /> Corrective Action : [ ) [ ) !1011-operational <br /> Ilerfot-ujec) [ ) I1eyuired <br /> Status @ Departure : [ ] Ol�eratiotial <br /> [ ] Mott-operational <br /> l G� , <br />