Laserfiche WebLink
e <br /> Abp � # 155954 WORK ACKNOWLEDGEMENT FORM " <br /> E-MAINTENANCE TICKET NO: ZDATE: <br /> FACILITY NO. &ADDRESS: ; <br /> GETTLER-RYAN INC- <br /> VENDOR NAME&ADDRESS: 6742 SIP-RR A ('_()THM 9-M T <br /> SERVICE REQUESTED: DUBLIN,CALIFORNIA 94568 -1 <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 �149 _ <br /> - - - <br /> ld•�' - - <br /> c<3eo,C -- <br /> AgW <br /> -- -- <br /> - . _ u <br /> _ - --- --� <br /> WO Ft <br /> Are all sensor(s) located at the lowest point? Chain attached to shear valve? Debris removed from UDC? <br /> Q�❑ N IJ NA J J ONA, ❑ Y ❑ N A <br /> Have all sump lids and is enser panels been LJ ECS Notified of liquid found in Vapor equipment repairs <br /> I secured and sealed? ❑N :1NA containment sumps documented in Repair Log? <br /> SIA only if no sumps or dispensers ere opened. _ — ❑ Y ❑ N A_� <br /> NUMBER OF PERSONNEL ARRIVAL TIME C �Q DEPARTURE TIME <br /> TOTAL HOURS (MINUS MEALS) z <br /> TECHNICIAN P T NAME N ME OF DEAL R/MANA R <br /> E <br /> ICI <br /> SIG URE GNATURE DEAL ANAGER <br /> DISTRIBUTION: iITE- Invoice copy CANARY-Site copy( PINK-Vendor copy <br />