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er: U�C.T/Zliiz. Site# <br /> MONITOR WELLS <br /> Well Number 1 2 J 3 4 5 6 7 1 8 9 10 11 12 <br /> Well Depth ! a. <br /> Depth to Water /- ; <br /> Product Detected <br /> AI&OUNT Ire inches <br /> Standard Symbols for diagram below: F Fill V 'Vapor Recovery <br /> /B V.R. w / Ball Float M Monitor Well <br /> Observation Well ' <br /> (Outside Tank Bed Area) (Inside Tank Bed Area) <br /> B Ball Float ® Tank Gauge o Vent <br /> M ManwayI Iron Cross T Turbine <; <br /> Location Dia ram—Include the Va or Recovery System. f c1Aj, ;k <br /> . Eil . . . . <br /> . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . ' . . . <br /> . . . � . . . . . . . . . . <br /> i; . s ®. Q <br /> C3�w 4 <br /> {� . . . . . . . . : <br /> . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . r <br /> 1. <br /> . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . __ <br /> . . . . . <br /> . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Vapor Recovery System &Vents were tested vioVtank? <br /> Parts and Labor used <br /> General Comments <br /> When OWNER or local regulations require immediate roports of system failure-Complete the following: <br /> REPORTED NAME DATE T{YE , <br /> TO: <br /> Phone# OWNER or Regulatory ` <br /> eg ryAgency FILE NUMBER <br /> i <br /> Pnnt Certified Testers Name acuter cation Number- " <br /> AL <br /> r / x `� <br /> r i Ni: <br /> Certified Testers Signa - Date Testing Completed ." <br /> Form- tdalllr <br />