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So# +D%*.r: s <br />0 Site# <br />MONITOR WELLS <br />Well Number 1 2 3 <br />4 1 <br />5 6 718_ <br />9110 <br />11 1"2 <br />Well Depth <br />' <br />Depth to Water <br />Product Detected <br />AMOUNT in inches <br />Standard Symbols for diagram below: OFill <br />/B V.R. w / Ball Float OM Monitor Well <br />B (Outside Tank Bed Area) <br />Ball Float GO Tank Gauge <br />M Manway a Iron Cross <br />UV Vapor Recovery <br />0 Observation Well <br />(Inside Tank Bed Area) <br />O Vent <br />a Turbine <br />Location Diagram -Include the.Vapor Recovery System. . . <br />............................. <br />............................. <br />............................. <br />............................. <br />. <br />. P l <br />. . . . . . . . . . . . . life-. <br />. . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . D <br />Z <br />. . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . <br />. . . . . . . . . . . . .�G�(t� <br />Vapor Recovery System & Vents were tested with which tank? <br />O 1 NI LS <br />I `n a A <br />e <br />_ . <br />. <br />. . . . . .. <br />. . . . . . . . . . <br />. . . . . . . . . . <br />. . . . . . . . <br />�F <br />. . . . . . . . . . <br />. . . . . . . . . . <br />. . . . . . . . <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 />TO: <br />NAME <br />DATE <br />TIME <br />Phone# <br />OWNER or Regulatory Agency <br />FILE NUMBER <br />Print Certified Testers Name <br />VacutectlgCertification Number <br />Certified Testers Signature <br />Date Testing Completed <br />F0M-Tan WU**QFW <br />