Laserfiche WebLink
by 1\\ # 144407 <br /> WORK ACKNOWLEDGEMENT FORM " <br /> o� <br /> E-MAINT `or <br /> ENANCE TICKET NO: ` DATE: <br /> FACILITY NO.&ADDRESSS <br /> INC. <br /> VENDOR NAME&ADDRESS: 6747 SIERRA COURT STE. <br /> SERVICE REQUESTED: %-Iti-LWORNLAS <br /> ❑TANK/LINE TIGHTNESS 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. PFJfU -r <br /> o s'- 1 1b�ct U Ira - Z a <br /> sem, riaC115 5SCN— 13Q CA(I <br /> till <br /> Are all sensor(s)located at the lowest point? Chain attached to shear valve? Debris removed from UDC? <br /> "Sr-Y 13 L11 NA ❑ Y ❑ N 1WNA ❑ Y ❑ N NA <br /> Have all sump lids and dispenser panels been ❑ECS Notified of liquid found in Vapor equipment repairs <br /> secured and sealed?-'t#-Y ❑ N ❑ NA containment sumps documented in Repair Log? <br /> A only if no sumps or dispensers were opened. ❑ Y ❑ N �-.VNA <br /> NUMBER OF PERSONNEL �" ARRIVAL TIME DEPARTURE TIME <br /> TOTAL HOURS (MINUS MEALS) <br /> TECH CIAN PRINT AME NAME F DEAL R/ NAGER <br /> A - <br /> TEC IANTURE SIGNATUR OF ALER/MANAGER <br /> DISTRIBUTION: W ITE - Invoice copy / CANARY-Site copy/ PINK-Vendor copy <br />