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by �� # 142641' <br /> WORK ACKNOWLEDGEMENT FORM AL <br /> l ? / `F <br /> E-MAINTENANCETICKETNO: _ � �Y 3 C/ DATE: J J( <br /> FACILITY NO.&ADDRESS: r=FLER � t$ �� <br /> VENDOR NAME&ADDRESS: 6747 SIERRA COURT,STE.I <br /> SERVICE REQUESTED: <br /> ❑TAN K/UNETIGHTNESS TEST ZWACILTTYINSPECTION UENVIRONMENTAL REPAIRS <br /> D VAPOR RECOVERY TEST USECONDARY 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. U ANNULAR TANK NO. <br /> ALL ALARMS CLEARED U Y O N <br /> PLEASEPRINTLEGIBLY - <br /> RECQ MAR 0 52 n� <br /> Are all sensor(s) located at the lowest point? Chain attached to shear valve? Debris removed from UDC? <br /> DY UN DNA 0 DN DNA DY ON DNA <br /> Have all sump lids and dispenser panels been ❑ECS Notified of liquid found in Vapor equipment repairs <br /> secured and sealed? U Y U N D NA containment sumps documented in Repair Log? <br /> A only if no sumps or dispensers were opened. U Y U N U NA <br /> NUMBER OF PERSONNEL_ ARRIVAL TIME DEPARTURE TIME 2,l <br /> TOTAL HOURS (MINUS MEALS) <br /> �-c <br /> TECHNICIAN PRI E OF D A ER <br /> TECHNICIAN SI ATURE GNATURE OF DEALER/MANAGER <br /> DISTRIBUTION:WHITE-Invoice copy / CANARY-Site copy/ PINK-Vendor copy <br />