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SO* a a 0v0r: Site# <br />MONITOR WELLS <br />Well Number 1 2 3 4 5\ 6 7 8 9 10 11 12 <br />Well Depth <br />Depth to Water <br />Product Detected <br />AUCIUNT in in�hae <br />Standard Symbols for diagram below:Fill <br />Vapor Recovery <br />GV.R. w / Ball Float <br />UM Monitor Well <br />O Observation Well <br />© Ball Float <br />(Outside Tank Bed Area) <br />@ Tank Gauge <br />(Inside Tank Bed Area) <br />O Vent <br />0 Manway <br />ID Iron Cross <br />[11 Turbine <br />L cation Diagram -include the.Vapor Recovery System. . . . <br />. <br />. .... <br />. <br />. <br />. . . . . . . . . . <br />C. . . . <br />. . <br />. . . . . . . . . <br />. . . <br />. . . . . . . . . <br />. . . . . . . . . <br />i <br />. . . <br />. . <br />. . . . . . . . .. <br />. . .. . .. .. .. . . <br />El <br />............. <br />. <br />Lid La <br />L- <br />......... <br />. . . . . . . . . <br />. <br />........... <br />..\/ <br />V. 0 <br />0 <br />. . . . . . . <br />#(-1 <br />�a2 <br />. <br />/ <br />11 <br />Vapor Recovery System & Vents were tested with which tank? 00e) <br />4rz/ <br />Parts and Labor. used <br />General Comments <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />NAME <br />DATE <br />TIME <br />TO: <br />Phone# <br />OWNER or Regulatory Agency <br />FILE NUMBER <br />Print: Certified Testers Name <br />VacutecVm Certification Number <br />ID -r—_017) ), I'AZo. <br />7_3 <br />Certified Testers Signature <br />Date Testing Completed <br />Form-TarAdli as-OrM <br />